Breastfeeding and Child Spacing

LAM - Lactational Amenorrhea Method(1)

recent press release from Bellagio, Italy, reporting on a meeting of international scientists and policy makers, affirms the importance of breastfeeding to achieve proper birth spacing. Birth spacing improves both the mother's health and her infant's survival. Infants born within two years of their older siblings have more than twice the risk of dying compared with infants born more than two years after their sibling.(2) This second Bellagio conference, co-sponsored by the World Health Organization, the Georgetown University Institute for Reproductive Health and Family Health International, released a Consensus Statement endorsing the Lactational Amenorrhea Method (LAM) for family planning.

Knowledge that breastfeeding can delay the return to fertility is the basis for the LAM method of family planning. This new Consensus Statement defines more clearly how women can reliably take advantage of this fact. The first Bellagio Consensus Statement,(3)(4) concluded, after reviewing theavailable science, that women who are not using other forms of family planning, and who are fully breastfeeding, will experience a risk of pregnancy of less than two per cent during the first six months after delivery. Subsequent studies have again concluded the validity of the 1988 statement and in addition, shown that women who are fully or nearly fully breastfeeding are at a risk of less than two per cent of becoming pregnant. When appropriate breastfeeding practices were promoted, the percentages of women still amenorrheic and still fully breastfeeding at six months post partum were higher than in groups receiving no such support.

Guidelines for LAM were developed after the 1988 statement and included the three criteria for effective infertility: a woman must be:

1. amenorrheic,
2. fully or nearly fully breastfeeding, and
3. no more than six months post partum.

The recent Bellagio Consensus group reached further conclusions on the importance and efficacy of LAM.

1. The end of amenorrhea is the clearest marker indicating increased risk of pregnancy.

    

2. Full or nearly full breastfeeding is recommended for the first six months post partum, to ensure both amenorrhea and optimal infant health. With the introduction of complementary foods and subsequent decreased breastfeeding stimulus, the return of menses may be hastened. Whether this increases the risk of pregnancy before six months post partum remains to be studied.

    

3. It may be possible to extend LAM beyond six months post partum. Many of the studies reviewed showed that women who continued to breastfeed despite the addition of complementary foods retained a low risk of pregnancy, although somewhat higher than at six months. This suggests the possibility of extending the use of LAM. Further research is needed, however, to establish the conditions under which extended use can be recommended as a method.

References

1. Press Release, December 14, 1995, Bellagio, Italy Family Planning Method Endorsed, Family Health International, World Health Organization, Georgetown University Institute for Reproductive Health. Back

2. Thapa, S, et al. Breastfeeding, birth spacing and their effects on child survival. Nature 335:679-82, 1988. Back

3. Bellagio Consensus Statement. Breastfeeding as a Family Planning Method. Lancet, ii:1204-1205, 1988. Back

4. Kennedy, K. I. et al. Consensus Statement on the Use of Breastfeeding as a Family Planning Method. Contraception 39:477-496, 1989. Back

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