The Current Status of Postpartum Menstrual Resumption Delay and Associated Risk Factors in Japanese Women: An Adjunct Study of the Japan Environment and Children's Study.

Background: Prolonged postpartum amenorrhea is a sign of secondary infertility. However, there are no reports on postpartum menstrual resumption delay in Japanese women. We conducted an Adjunct Study of the Japan Environment and Children's Study (JECS) to elucidate the actual state of postpartum menstrual resumption delay in Japan and related factors. Methods: An Adjunct Study questionnaire was sent to 2,729 mothers who participated in the study of Shinshu Subunit Center in the JECS, and 762 mothers were included in the analysis. The participants were categorized into the normal and delayed groups based on the weeks of postpartum menstrual resumption. To investigate the factors associated with postpartum menstrual resumption delay, a multiple logistic regression analysis was conducted with the weeks of postpartum menstrual resumption as the dependent variable. Results: The study included 762 women, of which 61 (8.0%) had delayed menstruation, not occurring until 72 weeks postpartum. The multivariate analysis revealed a significant correlation between postpartum menstrual resumption delay and age at delivery, past history of irregular menstruation, history of taking oral contraceptives, breastfeeding at 18 months, and the level of satisfaction with the husband's participation in childcare. Conclusion: Postpartum menstruation in Japanese women occurred later than before. In addition to previous findings, another factor was the husband's satisfaction with his participation in childcare. We should not only focus on the physical aspects of mothers, but also provide midwifery care that proposes and supports family planning suitable for each family.

Effects of Breastfeeding on Endometriosis-Related Pain: A Prospective Observational Study.

Endometriosis is a gynecological estrogen-dependent disease whose commonest pain symptoms are dysmenorrhea, dyspareunia, and acyclic chronic pelvic pain (CPP). Hormonal changes occurring during breastfeeding seem to reduce pain and disease recurrence. The aim of this observational prospective study was to assess the effect of breastfeeding on pain and endometriotic lesions in patients with endometriosis and to evaluate a possible correlation between the duration of breastfeeding, postpartum amenorrhea, and pain. Out of 156 pregnant women with endometriosis enrolled, 123 who breastfed were included in the study and were monitored for 2 years after delivery; 96/123 exclusively breastfed for at least 1 month. Mode of delivery, type and duration of breastfeeding, intensity of pain symptoms, and lesion size before pregnancy and during the 24-month follow-up were analyzed. All patients experienced a significant reduction in dysmenorrhea proportional to the duration of breastfeeding. CPP was significantly reduced only in women who exclusively breastfed. No significant improvement in dyspareunia was observed. Ovarian endometriomas were significantly reduced. Therefore, breastfeeding, particularly if exclusive, may cause improvement in dysmenorrhea and CPP proportional to the duration of breastfeeding, as well as a reduction in the size of ovarian endometriomas.

Socioeconomic development predicts a weaker contraceptive effect of breastfeeding.

The contraceptive effect of breastfeeding remains essential to controlling fertility in many developing regions of the world. The extent to which this negative effect of breastfeeding on ovarian activity is sensitive to ecological conditions, notably maternal energetic status, has remained controversial. We assess the relationship between breastfeeding duration and postpartum amenorrhea (the absence of menstruation following a birth) in 17 World Fertility Surveys and 284 Demographic Health Surveys conducted between 1975 and 2019 in 84 low- and middle-income countries. We then analyze the resumption of menses in women during unsupplemented lactation. We find that a sharp weakening of the breastfeeding-postpartum amenorrhea relationship has globally occurred over the time period analyzed. The slope of the breastfeeding-postpartum amenorrhea relationship is negatively associated with development: higher values of the Human Development Index, urbanization, access to electricity, easier access to water, and education are predictive of a weaker association between breastfeeding and postpartum amenorrhea. Low parity also predicts shorter postpartum amenorrhea. The association between exclusive breastfeeding and maintenance of amenorrhea in the early postpartum period is also found in rapid decline in Asia and in moderate decline in sub-Saharan Africa. These findings indicate that the effect of breastfeeding on ovarian function is partly mediated by external factors that likely include negative maternal energy balance and support the notion that prolonged breastfeeding significantly helps control fertility only under harsh environmental conditions.

Fear of infertility limits contraceptive usage among first-time mothers in Ghana: A cross-sectional study.

OBJECTIVES: This study aimed to determine postpartum modern contraceptive use among first-time young mothers attending child welfare clinics in the Eastern Region of Ghana and explore factors that influence family planning uptake after the first delivery, including fear of infertility. METHODS: This facility-based, cross-sectional study used interviewer-administered structured questionnaires. The study recruited 422 first-time young mothers aged 15-24 years, with 6- to 18-month-old babies attending child welfare clinics. RESULTS: Overall, less than half (44%) of first-time mothers used modern contraceptives within 18 months after delivery. Fear of infertility after contraceptive use (56%) is the main barrier reported as the reason for women's non-use of modern contraceptives. Mothers with tertiary education have higher odds of using postpartum contraceptives (adjusted odds ratio =1.6, 95% confidence interval: 0.4-2.0). Compared to mothers with younger children, those with children older than 6 months have higher odds of postpartum contraceptive use (adjusted odds ratio = 1.3, 95% confidence interval: 0.3-1.7). Nonspousal communication (adjusted odds ratio = 0.1, 95% confidence interval: 0.1-0.3) as compared to communication among partners about contraception and those in formal employment (adjusted odds ratio = 0.3, 95% confidence interval: 0.1-0.7), were less likely to use postpartum contraceptives. CONCLUSION: Considering that there is low postpartum contraceptive utilization, mostly due to concerns about fear of infertility after use, it is paramount to intensify education on actual side effects and reformulate policies that address specific concerns of infertility among mothers and contraceptive use.

Sheehan Syndrome: An Unusual Presentation Without Inciting Factors.

Background: Sheehan syndrome (SS) is a rare complication of severe postpartum hemorrhage or hypotension during the processes of labor and delivery that results in ischemic pituitary infarction and necrosis. In this case report, we describe an unusual presentation of SS without inciting factors. Case Presentation: A 30-year-old multiparous woman presented 2 hours after a normal spontaneous vaginal delivery with a profound severe headache, and subsequent agalactia, dry skin, and mood changes. She was managed conservatively until 10 months postdelivery when she complained of persistent symptoms including amenorrhea. A brain magnetic resonance (MR) with pituitary imaging revealed findings consistent with SS. The patient's symptoms improved and ultimately resolved after levothyroxine, estrogen replacement therapy, and hydrocortisone were instituted. Conclusions: SS can present without recognized inciting factors. During the initial phase, women may present with profound headache and/or visual disturbances warranting neurological evaluation. A high index of suspicion and a brain MR with pituitary imaging should prompt early consideration of SS to aid in the diagnosis.

Interbirth intervals in wild baboons: Environmental predictors and hormonal correlates.

OBJECTIVES: Interbirth intervals (IBIs) are a key metric of female reproductive success; understanding how they are regulated by environmental, social, and demographic factors can provide insight into sources of variance in female fitness. MATERIALS AND METHODS: Using 36 years of reproductive data on 490 IBIs for 160 wild female baboons, we identified sources of variance in the duration of IBIs and of their component phases: postpartum amenorrhea (PPA), sexual cycling, and pregnancy. We also examined how body fat and fecal hormone concentrations varied during female IBIs. RESULTS: We found that IBIs tended to be shorter (reproduction was accelerated) when female traits and environmental variables promoted energy acquisition, but with different specific effects for different component phases of the IBI. We also found that females lost a substantial amount of body fat during PPA, indicating that PPA imposes accumulating energetic costs as it progresses. Prior to cycle resumption females began to regain body fat; body fat was stable across the cycling phase and increased throughout most of pregnancy. However, body fat scores per se were not associated with the duration of any of the component phases. Finally, we found that fecal glucocorticoid concentrations decreased as PPA progressed, suggesting a decline in energetic stress over this phase. Fecal progestogen and estrogen concentrations changed over time during sexual cycling; the direction of these changes depended on the phase of the sexual cycle (luteal versus early or late follicular phases). DISCUSSION: Our study lends insight into the energetic constraints on female primate reproduction, revealing how female environments, changes in body fat, and steroid hormone concentrations relate to IBI duration and to reproductive readiness.

Reproductive characteristics of wild Sanje mangabeys (Cercocebus sanjei).

An accurate description of reproductive characteristics and ovarian endocrinology is necessary to address questions about the reproductive strategies and life history of a species and for meaningful, cross species analyses. Here we used analysis of fecal estradiol (fE) and behavioral observations to determine for the first time the reproductive characteristics and endocrinology of a wild group (N = 18 adult and 3 adolescent females) of Sanje mangabeys (Cercocebus sanjei). The study was conducted in the Udzungwa Mountains National Park, Tanzania, from October 2008 through September 2010. Average cycle length (±SD) was 29.3 ± 3.2 days in adults and 51.4 ± 5.5 days in adolescents. Menses appeared within 5.1 ± 2.1 days in adults and 4.8 ± 0.3 days in adolescents after the end of maximum tumescence, and lasted 6.7 ± 3.1 and 10.3 ± 5.0 days, respectively. Infant death tended to reduce the number of cycles to conception (4.3 ± 1.5 cycles after a surviving infant vs. 2.6 ± 1.0 cycles after infant death). Adolescents cycled for at least 16 months without conceiving. Implantation bleeding began 17.5 ± 0.7 days from the onset of detumescence, and lasted 10.0 ± 1.4 days. Gestation length averaged 171.8 ± 3.4 days. Postpartum amenorrhea lasted 6.7 ± 2.3 months while females whose infants had died resumed cycling within 14.3 ± 5.9 days. The interbirth interval after a surviving infant averaged 20.0 ± 4.3 months. These reproductive characteristics of the Sanje mangabey resembled those of other mangabeys and related cercopithecines, with the exception of an earlier onset and longer duration of menstruation and implantation bleeding. Further information on the physiology of the Sanje mangabey is needed to clarify what factors may cause the unusual characteristics of both, their menses and implantation bleeding.

Using complete breastfeeding and lactational amenorrhoea as birth spacing methods.

The aim of this study was to evaluate the effectiveness of lactational amenorrhoea and to determine the relationship between extended breastfeeding and the return of fertility. Breastfeeding pattern, basal body temperature, cervical mucus, salivary ferning, vaginal blood discharge, frequency of sexual intercourse, and the presence of ovulation in the first cycle after the resumption of menses with ultrasonography were evaluated in 40 women. All subjects completed the study with only one case of incomplete breastfeeding. No pregnancies were observed. The mean number of feeding sessions and mean interval between sessions decreased significantly (p <0.01) during the first six months postpartum (7.5 +/- 1.3 after 60 days postpartum vs. 5.7 +/- 2.1 after 180 days, and 3.6 +/- 0.8 vs. 5.1 +/- 0.9, respectively). Eight women (20%) menstruated before weaning, but none had an adequate thermal shift, while 32 (80%) had their first vaginal bleeding after weaning with 12 (37.5%) registering an adequate thermal shift. Both basal body temperature and salivary ferning proved to be suggestive of ovarian activity, while mucus characteristics were not reliable in identifying fertile periods. Our study showed that breastfeeding associated with lactational amenorrhoea proved to be a good method of postpartum fertility control. Since the importance of supplementation is still debated, it is recommended that a "complete" breastfeeding program be used.

Continuously recorded suckling behaviour and its effect on lactational amenorrhoea.

The hypothesis that the month-specific rate of return to ovarian cyclicity after childbirth is causally related to suckling pattern was tested for a population of New Mexican women recruited within the service area of New Mexico Highlands University and for a nationwide USA subpopulation of women recruited through membership of the Couple to Couple League (CCL). Survival analysis for time-dependent covariates was used, and significant predictors of the first postpartum menses were found. Important differences were detected in the suckling pattern for the two groups and a 5:2 differential was found in their respective rates of menstrual cycle recovery. Although the two groups were comparable perinatally, daily and time-windowed breast-feeding performance fell off at twice the rate for the New Mexico population when contrasted with the CCL sample. For both populations, the introduction of solid feeds was a strong and significant predictor of returning menstrual cyclicity, independent of suckling pattern.

PIP: This study hypothesizes that the pattern of suckling behavior throughout the day and night significantly affects the timing of postpartum menstrual cycle recovery. The study was tested in New Mexican women recruited within the service area of New Mexico Highlands University and US women recruited nationwide through the Couple to Couple League (CCL). Survival analysis for time-dependent covariates found significant predictors of the first postpartum menses. Important differences were detected in the suckling pattern for the two groups, and a 5:2 differential was found in their respective rates of menstrual cycle recovery. Results of the analysis associate the mother's separation from her baby in order to work outside the household with a drastic shortening of the postpartum amenorrhoeic interval. Although both groups showed a significant dependence on breast-feeding performance and on the delay of solid feeds for the maintenance of postpartum amenorrhoea, daily and time-windowed breast-feeding, in the New Mexico population performance fell off at twice the rate of that of the CCL sample. Thus, the introduction of solid feeds was a strong and significant predictor of returning menstrual cyclicity, independent of suckling pattern.

From efficacy to effectiveness: selecting indicators for a community-based lactational amenorrhoea method promotion programme.

This paper reviews the results of clinical trials and community studies of lactational amenorrhoea and its role as a contraceptive method (LAM). Indicators which are used in efficacy trials and effectiveness interventions are compared and sets of indicators of effectiveness appropriate to community-based LAM programmes are recommended. A five-tiered ecological framework is used to facilitate selection of indicators which range from individual to policy level outcomes. The indicator framework is intended as a tool for health practitioners in family planning and maternal and child health service delivery settings who are interested in designing programmatic interventions for the promotion of LAM, particularly among less well-educated women of lower socioeconomic communities.

PIP: If lactational amenorrhea (LAM) is to reach its full potential as a method of child spacing, additional programmatic interventions must be conducted at the community level--especially in developing countries--to demonstrate its effectiveness. A review of clinical trials and community studies of LAM conducted both before and after the Bellagio Consensus Conference was undertaken in order to develop a set of indicators for the effectiveness of LAM promotion efforts under a range of field conditions. The resultant framework is intended as a tool for health professionals in family planning and maternal-child health service delivery settings who are interested in designing community-based LAM programs. A 5-tiered (individual, interpersonal, community, health system, and macro-policy factors) ecological systems model was used as the framework for indicator development. Laboratory, physiological, and behavioral measures were rated and weighted according to their scientific rigor (quality of data collected, technical feasibility), administrative feasibility (cost to administer, time required and likelihood of compliance), and community appropriateness (cultural sensitivity, contribution to women's knowledge and skills). Included among the suggested indicators are hormonal levels in urine or blood samples, timing of first vaginal bleed, duration of breast feeding, use of pacifiers or nipples, breast feeding knowledge and cultural influences, number of breast feeds per 24 hours, and frequency of intercourse.

Postpartum amenorrhoea in rural eastern Uttar Pradesh, India.

This paper calculates the mean duration of the postpartum amenorrhoea (PPA) and examines its demographic, and socioeconomic correlates in rural north India, using data collected through 'retrospective' (last but one child) as well as 'current status' (last child) reporting of the duration of PPA. The mean duration of PPA was higher in the current status than in the retrospective data; the difference being statistically significant. However, for the same mothers who gave PPA information in both the data sets, the difference in mean duration of PPA was not statistically significant. The correlates were identical in both the data sets. The current status data were more complete in terms of the coverage, and perhaps less distorted by reporting errors caused by recall lapse. A positive relationship of the mean duration of PPA was found with longer breast-feeding, higher parity and age of mother at the birth of the child, and the survival status of the child. An inverse relationship was found with higher education of a woman, higher education of her husband and higher socioeconomic status of her household, these variables possibly acting as proxies for women's better nutritional status.

PIP: The differentials of the mean duration of postpartum amenorrhea (PPA) were investigated in a study conducted in five villages in the Varanasi district in Uttar Pradesh State, India, in 1995. Information was collected from 1060 mothers about their last birth and from 767 mothers about the penultimate birth. Following a peak at 1 month's duration, the PPA distribution showed heaping at durations of multiples of 6. The mean duration of PPA was 7.2 months after the birth of the last child and 7.7 months when the duration between the date of the last birth and the survey date was used for the analysis. Survival analysis indicated that the chance of resumption of menses at 3 months postpartum was 44% after the birth of the last child and 49% for the last but one child. The shorter duration of PPA in the latter group may reflect differences between retrospective and current status data quality. Multivariate analysis revealed that the duration of PPA increased with longer durations of breast feeding, higher parity and maternal age, and if the child survived to the next birth or the time of the survey. PPA duration was negatively associated with maternal and paternal education, higher socioeconomic status, and residence in a pukka house--variables that may be proxies for improved maternal nutrition status.

Tanzania 1996: results from the demographic and health survey.

PIP: The Tanzania Demographic and Health Survey (TDHS) was conducted by the Bureau of Statistics Planning Commission, Dar es Salaam, in collaboration with the Ministry of Health. Data for the nationally representative survey were collected from 7969 households, and complete interviews were conducted with 8120 women aged 15-49 years and 2256 men aged 15-59 during July-November 1996. Summary statistics are presented under the following headings: general characteristics of the population; percentage distribution of women surveyed; fertility trends; fertility differentials, 1992-95; mean ideal number of children, by age and number of living children for all women; desire to stop childbearing among all women, by number of living children; percentage distribution of births in the 5 years preceding the survey, by planning status, according to birth order, 1996; contraceptive prevalence differentials; differentials in median age at first birth; union and contraceptive status; differentials in duration of breast-feeding; median duration of postpartum interval; infant mortality trends; infant mortality differentials, 1986-96; and children ever born, surviving, and proportion dead. Data are also reported on the percentage of children aged 12-23 months who have received specific vaccines, the incidence of diarrhea and its treatment among children under age 5 years, the types of assistance provided during delivery, and anthropometric measures with regard to child nutritional status.^ieng

Lactation and fertility.

Breastfeeding suppresses ovarian activity resulting in amenorrhea and infertility. The frequency of breastfeeds and their duration appear to be important in maintaining amenorrhea--and night-time sucking appears to be particularly crucial. Supplementary feeding may affect fertility by altering suckling behaviour, but the evidence is confusing as to whether feeding supplements reduces the duration of amenorrhea and increases the risk of conception. Mothers who are better nourished tend to have a shorter period of amenorrhea than the malnourished, possibly because the infant has to suckle for a shorter period to obtain the nourishment needed. Lactation has an important effect on fertility at the population level. However, it cannot be considered a reliable contraceptive at an individual level.

PIP: Breast feeding suppresses ovarian activity, resulting in amenorrhea and infertility. The frequency of breast feeds and their duration appear to be important in maintaining amenorrhea, and night-time sucking appears to be particularly crucial. Supplementary feeding may affect fertility by altering suckling behavior, but the evidence is confusing as to whether feeding supplements reduce the duration of amenorrhea and increase the risk of conception. Mothers who are better nourished tend to have a shorter period of amenorrhea than those who are malnourished, possibly because the infant has to suckle for a shorter period to obtain the nourishment needed. Lactation has an important effect on fertility at the population level. However, it cannot be considered a reliable contraceptive at an individual level.

Egypt 1995: results from the demographic and health survey.

PIP: This article provides summary statistics in tables and charts of data from the 1995 Egypt Demographic and Health Survey. There are 27 tables or charts that concern population characteristics, fertility, fertility preferences, contraceptive use, marital status, breast feeding and postpartum amenorrhea, infant mortality, immunization and child diarrhea morbidity, assistance at delivery, and extent of child undernourishment. Fertility in 1995 was 3.5 children per woman: 3.0 in urban areas, 4.2 in rural areas, 4.6 among uneducated women, and 3.0 among women with at least a secondary education. Fertility was 67/1000 women per year among women 15-19 years old in the 4 years preceding the survey, 213/1000 women 25-29 years old, and 211/1000 women 20-24 years old. Fertility declined in each age group over time and with increasing age. The mean ideal was 2.5 among women with no children. The mean ideal rose to 3.6 among women with 6 or more children, and to 3.3 among women 45-49 years old. 69.0% of all births were wanted. Among wanted births, the percentage of wanted births dropped sharply to 46.2% at the fourth or higher birth order from 69.1% at the third birth and 95.6% at the first birth. 10.5% of all births were wanted later. 20.2% of births were unwanted. Modern contraceptive prevalence was 45.5%. Contraceptive prevalence ranged from a low of 39.1% among the uneducated to 52.9% among women with at least some secondary education. The highest contraceptive prevalence was among women living in urban areas. 62.7% of all methods were obtained from private sources. The most frequently used method was the IUD with 30% of women users. 10.4% of women used the pill. 21.3% of currently married women who were nonusers did not intend to use, and 15% who were previous users did not intend to use. Infant mortality was an estimated 63/1000.^ieng

Regression analysis of the effect of full and partial lactation on post-partum amenorrhoea in lower middle class Indian females.

This study presents a simple regression analysis of the impact of full and partial breast feeding on post-partum amenorrhoea (PPA) in lower middle class Indian women. The study has been done on a sample of hospital based data collected in 1992. The analysis shows a highly significant correlation. Further, the impact of lactation on PPA was notably less in case with partial breast feeding as compared to those with full breast feeding.

PIP: The influence of full and partial breast feeding on the duration of postpartum amenorrhea was investigated in 292 lower-middle-class women who delivered at Sir Sundar Lai Hospital in Varanasi, India, in 1992. In the 205 fully breast-feeding mothers, the coefficient of correlation between postpartum amenorrhea length and total lactation was 0.3899 (p 0.001). For women with a duration of lactation under 18 months and postpartum amenorrhea less than 12 months, the correlation coefficient was not significant. Among women with postpartum amenorrhea lasting 6 or more months and a total lactation period of 12 or more months, the correlation coefficient was 0.4081 (p 0.001). Finally, the correlation coefficient between the length of postpartum amenorrhea and duration of lactation in the 87 women who partially breast fed was 0.27075 (p 0.05). The finding of a greater influence of total than partial breast feeding suggests the presence of a qualitative association between lactation and postpartum amenorrhea.

Effects of age at introduction of complementary foods to breast-fed infants on duration of lactational amenorrhea in Honduran women.

Lactational amenorrhea (LA) is associated with postpartum infertility and is known to be related to breast-feeding frequency and duration, but the exact role of complementary feeding of the infant has not been clearly defined. Data on LA were collected during and after a 2-mo intervention trial in which low-income Honduran women who had breast-fed fully for 4 mo were randomly assigned to one of three groups: continued full breast-feeding until 6 mo (FBF, n = 50), introduction of complementary foods at 4 mo with ad libitum breast-feeding from 4 to 6 mo (SF, n = 47), or introduction of complementary foods at 4 mo with maintenance of baseline breast-feeding frequency from 4 to 6 mo (SF-M, n = 44). Women were followed up until the infant was 12 mo of age, or later if menses had not occurred by then. All but six of the women continued to breast-feed for > or = 12 mo. With the exclusion of those whose menses returned before 18 wk postpartum (which could not have been due to the intervention), the proportion of women who were amenorrheic at 6 mo was 64.5% in the SF group, 80.0% in the FBF group, and 85.7% in the SF-M group (chi-square test = 4.13, P = 0.02; one-tailed test with the latter two groups combined). The total duration of LA did not differ significantly among groups. The most significant determinant of LA was time spent breast-feeding (min/d), which was in turn negatively associated (P = 0.06) with the infant's energy intake from complementary foods in regression analyses. These results indicate that there is a significant effect of introducing foods at 4 mo on the likelihood of amenorrhea at 6 mo postpartum, but not thereafter, and that this effect is not seen in mothers who maintain breast-feeding frequency.

[IPPF declaration on breast feeding, fertility and postpartum contraception]. / Declaracao da IPPF sobre aleitamento materno, fertilidade e contracepcao pos-parto.

PIP: Mother's milk protects the newborn against various infections, especially against gastrointestinal infections, as well as strengthening the mother-child bond. Breast-feeding is also associated with birth spacing and plays an important role in the regulation of fertility in countries where the rate of use of contraceptives is low. In breast-feeding women amenorrhea may last several months or even a year, while in women who do not breast-feed menstruation returns 35-40 days postpartum. The risk of getting pregnant in women who rely on amenorrhea for contraception increases with the appearance of the first postpartum menstruation (spotting), with the introduction of food supplement into the diet of the infant, and approximately 6 months after childbirth. Family planning programs have to collaborate with maternal health programs with respect to the need for contraception, including postpartum contraception, which involves the training of nurse-midwives or traditional birth attendants. The choice of contraceptives includes the IUD, with a high degree of efficacy, which is particularly advantageous during breast-feeding. Tubal ligation has no negative effect on breast-feeding, but it also requires proper counseling. Other methods are vasectomy, implants and injectables containing progestational hormones, and estrogen-progesterone containing pills, which should not be used for 6 weeks after childbirth.^ieng

Integrated use of qualitative and quantitative methods to elicit women's differential knowledge of breastfeeding and lactational amenorrhea in periurban Bolivia.

PIP: Exclusive and extended breast feeding is responsible for much of the fertility limitation and child spacing throughout the world. In many developing countries, where breast feeding is almost universal and of long duration, postpartum amenorrhea protects women from closely spaced subsequent pregnancies. However, at the same time, increased pressures toward modernization, rapid rural-to-urban migration, frequent advertisements of powdered milk substitutes, and the increased employment of women outside of the home are adversely affecting traditional breast feeding practices. In Bolivia, almost all women breast feed their newborn infants, for periods up to 2 years. This paper reports findings which describe and compare patterns of women's differential knowledge of breast feeding and lactational amenorrhea resulting from data collection using a survey instrument and a focus group guide. The findings are part of a larger study on infant feeding and child spacing conducted in periurban communities in Bolivia. Current and historical trends with regard to paradigm and methodology in social science research are reviewed and the survey/focus group research method is described.^ieng

Research confirms LAM's effectiveness. Contraceptive update.

PIP: In December 1995, in Bellagio, Italy, 24 specialists in the lactational amenorrhea method (LAM) from nine countries served on a panel that analyzed the results of studies in more than 12 countries. These studies were coordinated by Family Health International, the World Health Organization, and Georgetown University's Institute for Reproductive Health (IRH). LAM is more than 98% effective during the first 6 months postpartum. The three criteria a woman must meet to use LAM correctly are: 1) she must be amenorrheic since delivery; 2) she must be fully or nearly fully breast feeding; and 3) she must be in the first 6 months postpartum. Should any of these criteria change, LAM users should switch to another family planning method if they wish to prevent pregnancy. The recent research suggests that increasing the 6-month criterion to 9-12 months after delivery might be possible under certain conditions (e.g., if breast feeding takes place immediately before each supplemental feeding). Further research is needed before amending this criterion, however. The most critical of the LAM criteria is being amenorrheic, since the end of amenorrhea indicates a return of ovarian activity. Based on the research findings, the specialists put together a consensus statement: The efficacy of LAM has now been well established in prospective studies, and programs should regard LAM as an additional method that increases family planning choices for postpartum women. The consensus also stated that the lactational amenorrhea method should receive the programmatic and policy support necessary to become available worldwide. IRH has developed and tested LAM use guidelines in five languages. The LAM specialists in Bellagio emphasized that they were not promoting LAM above other methods but rather validating its scientific effectiveness. They did not limit their promotion of breast feeding to LAM but also promoted breast feeding for its other benefits (e.g., it lowers an infant's risk of infection).^ieng

Effect of skim milk supplementation of the maternal diet on lactational amenorrhea, maternal prolactin, and lactational behavior.

Effect of skim milk supplementation of the maternal diet on lactational amenorrhea was studied in 30 pairs of healthy lactating women matched for parity, body mass index, and previous experience of lactational amenorrhea. Supplementation of the maternal diet had no significant effect on the time of resumption of regular menstruation or ovulation, maternal prolactin concentrations, breast-feeding pattern, maternal body mass index, or infant weight. However, the supplemented group breast-fed nearly exclusively (supplemental feeds were introduced but did not exceed 20% of total feeds) for a significantly longer duration (P < 0.05) than did the control group. Previous experience of lactational amenorrhea was significantly positively correlated with the time of resumption of menstruation in the supplemented (P < 0.01) and control (P < 0.05) groups when frequency of breast-feeding, maternal body mass index, and supplementary feeds to the infant were controlled for. Thus, maternal nutritional supplementation does not appear to affect the contraceptive benefit of lactation when the frequency of breast-feeding is not compromised but apparently lengthens the duration of nearly full breast-feeding.