Integrating the Lactational Amenorrhea Method into a family planning program in Ecuador.

ABSTRACT

PIP: The aim of this inquiry was to describe the planning and process of integration of the Lactational Amenorrhea Method (LAM), as a viable contraceptive option, into an existing family planning service network. LAM was introduced as a demonstration project in 1991 in 4 out of 20 available clinics nationwide operated by the private, nonprofit Centro Medico de Orientacio y Planificacion. Study sites included Quito in an urban mountainous area, Latacunga in a mixed urban/rural mountainous area, Cajabamba in an isolated area with indigenous populations, and Santo Domingo in a mixed urban/rural coastal area. A needs assessment of clients, staff, and organizational information system factors was conducted 4 months prior to introducing LAM into the pilot clinics. Organizational materials were prepared for clients, and a staff training program was implemented. Baseline information was obtained from 58 clients and 24 staff on the prevailing knowledge, attitudes, and practices of breast feeding and contraception. The educational materials included a wall chart on breast feeding promotion, a wall poster on contraception including LAM, a 12 page booklet for LAM clients, and a desk-size flip chart for one-to-one instruction. Record keeping was improved. LAM was introduced to all mothers with infants 6 months old, who were fully or nearly fully breast feeding and were amenorrheic, and identified by intake staff. Follow-up was after 3 months, unless there was a change in desires or a change in the LAM requirements. After 6 months of implementation, a qualitative evaluation was made. 50% of acceptors were interviewed (67, of which 23 were still using LAM). The results showed that 73% used LAM as their first ever contraceptive method. Compliance with follow-up and LAM instructions varied with each clinic. 87% of users and 67% of Quechua users expressed satisfaction with LAM. A number of observations were made about clinic operations. A refined training model was developed, and there was consensus that the 12-page booklet was the most useful. A well child program was integrated into the LAM program. A surprise finding was the low use among rural traditional ethnic groups. LAM is being included in outreach efforts and the expertise passed along to other health programs. The Pearl pregnancy index was 6.8%, which was comparable to other temporary methods in Andean countries.