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Lactational Amenorrhea Method (LAM) Frequently Asked Questions (FAQ)

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Lactational Amenorrhea Method (LAM) Frequently Asked Questions (FAQ) FAQ SHEET 3 From the LINKAGES Project Updated September 2001 FAQ Sheet is a series of publications of Frequently Asked Questions on topics addressed by the LINKAGES Project. This issue focuses on the Lactational Amenorrhea Method (LAM) and is addressed to the Child Survival and Family Planning Health Care Provider. QWhat is the Lactational Amenorrhea Optimal breastfeeding practices include exclu- Method (LAM)? sive breastfeeding for the first six months and breastfeeding with appropriate complementary The Lactational Amenorrhea Method (LAM) is a feeding for two years or more. LAM is a family modern, temporary family planning method that has planning method which supports improved been developed as a tool to help support both breastfeeding and family planning use. It is based breastfeeding, healthy child spacing, child sur- on the natural infertility resulting from certain pat- vival, and women’s health. terns of breastfeeding. “Lactational” means related to breastfeeding; “Amenorrhea” means not having menstrual bleeding; and “Method” means a tech- QHow effective is LAM? nique for contraception. LAM provides family planning protection compa- LAM is defined by three criteria: rable to other family planning methods. 1. the woman’s menstrual periods have not re- sumed, AND Pregnancies per 100 women in first 12 months of use 2. the baby is fully or nearly fully breastfed, AND Typical Use Perfect Use 3. the baby is less than six months old. Injectables 0.3 0.3 When any one of these three criteria is no longer IUD 0.8 0.6 met, another family planning method must be intro- LAM 2 0.5 duced in a timely manner to ensure healthy birth spacing. Combined Oral 6-8 0.1 Contraceptives Condom 14 3 Adapted from: the Essentials of Contraceptive Technology, Johns Hopkins Population Information Program, 1997. LINKAGES n Academy for Educational Development n 1825 Connecticut Avenue, NW Washington, DC 20009 Phone (202) 884-8700 n Fax (202) 884-8977 n E-mail [email protected] n Website www.linkagesproject.org exclusive, the better for mother triggering the hormonal mecha- QWhat are the three LAM and baby. The optimal pattern for nism that causes ovulation—and criteria? the baby is to be nursed fre- menses—to resume. quently and for as long as the in- A mother may not want to switch 1. The woman’s menstrual peri- fant wants to remain on the to other family planning methods ods have not resumed breast, both day and night. At night, no interval between when she no longer meets the Following childbirth, the resump- feedings should be greater than LAM criteria and may choose to tion of menses is an important in- six hours. continue to rely on lactational dicator of a woman’s return to amenorrhea for pregnancy delay. fertility. During breastfeeding a 3. The baby is less than six In this case the woman should be woman is less likely to ovulate. months old counseled to keep breastfeeding However, once a woman starts to frequently and to breastfeed be- At six months of age, the baby menstruate, ovulation has re- fore giving the infant other foods. should begin receiving comple- turned or may be imminent. She should be informed that her mentary foods while continuing to Bleeding during the first two risk of pregnancy increases. breastfeed. Introduction of water, months postpartum is lochial dis- liquids, and foods can reduce the charge and is not considered men- amount of sucking at the breast, strual bleeding. Menstruation is defined for LAM use as two con- secutive days of bleeding, or when a woman perceives that she has QWhat are the advantages and disadvantages of LAM? had a bleed similar to her men- strual bleed, either of which oc- Advantages Disadvantages curs at least two months Very effective Can only be used for postpartum. Provides up to 0.5 CYPs (Couple Years a short period (up to Protection) six months postpar- 2. The baby is fully or nearly tum) fully breastfed1 Has no side effects Requires Full Breastfeeding is the term ap- Does not require insertion of any device at breastfeeding plied to both exclusive breastfeeding the time of sexual intercourse frequently both day (no other liquid or solid is given May attract new family planning users and night to infant) and almost exclusive Contributes to family planning prevalence breastfeeding (vitamins, water, juice, directly and through increased acceptance or ritualistic feeds given infre- rates quently in addition to breast- Can be initiated immediately postpartum feeds). Nearly Full Breastfeeding means that the vast majority of Is economical and requires no commodities feeds given to infants are or supplies breastfeeds. Contributes to optimal breastfeeding prac- tices and therefore enhances maternal and While exclusive breastfeeding is infant health and nutrition not necessary for LAM to be effec- Acceptable to all religious groups tive, the closer the pattern is to Frequently Asked Questions on the Lactational Amenorrhea Method (LAM) 2 from initiating LAM during this period. QWhen can LAM be initi- QWhat are the optimal 1 ated? If a woman wants to start using breastfeeding practices LAM when she is more than two that contribute to LAM can be initiated at any time months postpartum, the health breastfeeding and LAM during the first six months post- care provider must carefully verify success? partum. The best time to begin that she has met the three criteria counseling a woman about LAM for LAM use since delivery. 1. Breastfeed as soon as possible and other family planning meth- after birth, and remain with ods is during the antenatal period the newborn for at least sev- to allow her to make an informed QWhat is the difference eral hours following delivery. choice about which method she between LAM, 2. Breastfeed frequently both wishes to use following the birth breastfeeding, and day and night. of her baby. LAM can be started amenorrhea? immediately postpartum. The 3. Breastfeed exclusively for the health care provider can help pre- s LAM is a contraceptive method, first six months: no water, pare the woman to begin based on the physiology of other liquids, or solid foods. breastfeeding immediately after breastfeeding. LAM is a 4. After the first six months birth and, if the woman has de- method of contraception that when complementary foods cided to use LAM, verify that she a woman consciously chooses are introduced, breastfeed understands the three criteria for to use to reduce her chance before giving complementary LAM use. of becoming pregnant by ad- foods. hering carefully to the three If a woman wants to initiate LAM 5. Continue to breastfeed for up criteria. use within the first two months to two years and beyond. postpartum, she must verify that s Breastfeeding is a feeding prac- 6. Continue breastfeeding even she has been fully or nearly fully tice. if mother or baby is ill. breastfeeding her baby since de- s Amenorrhea, or the absence of 7. Avoid using bottles, pacifiers livery. A woman may still be hav- menstrual bleeding, reflects a (dummies), or other artificial ing postpartum bleeding (lochial reduced risk of ovulation, but nipples. discharge) that may be similar to neither breastfeeding nor a monthly bleed. As long as she is amenorrhea is a family plan- 8. Mothers who are fully or nearly fully breastfeeding, ning method. breastfeeding should eat and the bleeding in the first two drink sufficient quantities to months does not disqualify her satisfy their hunger and thirst. 1 Guidelines: Breastfeeding, Family Planning, and the Lactational Amenorrhea Method (LAM). Institute for Reproductive Health, Georgetown University, 1994 (available in Arabic, English, French, Russian and Spanish). Frequently Asked Questions on the Lactational Amenorrhea Method (LAM) 3 not expect a high level of contra- QHow many return visits QWhat contraceptive ceptive protection from LAM, are needed by LAM even if she expresses milk during methods can be used the separation. Expressing users? after LAM? breastmilk may not be as effective as suckling at the breast in sup- When counseling a new LAM ac- When any one of the three crite- pressing ovulation, and for this ceptor, the health care provider ria for LAM use is no longer met reason a woman who expresses should discuss her follow-up or when a woman decides to stop her milk may not be able to rely needs and determine with the cli- using LAM, she needs to begin on LAM. In a study on LAM in ent how frequently she needs to using another contraceptive working women, the pregnancy be seen and what setting is most method for as long as she wants to rate increased to five percent. accessible for her. At the very prevent another pregnancy. Some women can make arrange- least, a client needs to return for Women who are breastfeeding ments to have their babies a visit if she perceives any and who switch to another brought to them to nurse and/or breastfeeding difficulties or as method should be advised on are able to go to their baby at soon as any one of the LAM crite- contraceptive options. Combined regular intervals. Women who are ria changes. An additional follow- oral contraceptive pills (COC) able to keep their babies with up visit at five to six months and combined injectables are not them at the work site, market, or postpartum is essential to deter- recommended before six months in the fields and are able to mine the client’s plans for switch- postpartum because they contain breastfeed their children fre- ing to another contraceptive estrogen, which may decrease the quently can rely on LAM. method and for introducing quantity of breastmilk. After six complementary foods when her months postpartum, a woman baby is six months old.
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