Lactational Amenorrhea Method (LAM) :

A critical yet underutilized element of maternal and infant health

In this session…

2

• Learn the basic mechanism of action and effectiveness of LAM

• Understand the definition of LAM and criteria for use

• List advantages and limitations of LAM • Identify opportunities for LAM counseling• Operationalize LAM for “transition” to

another modern method

What is LAM?

A family planning method for post partum women who meet the following criteria:

Menstruation has not returned

Mother is only breastfeeding Baby is less than 6 months

Photo: J. Cachan

Effectiveness of LAM

• LAM is 99.5% effective with correct use

• LAM is more than 98% effective with typical use

LAM Mechanism of Action

1. Nipple stimulation

2. Nerve impulses affect hormones

3. Increases milk production

4. Suppression of ovulation

• Attracts new FP users

• Serves as introductory / “gateway” FP method

• Contributes to healthy spacing of pregnancies

• Contributes to health of mother and child

• Supports optimal breastfeeding practices

Rationale for Integration of LAM into Programs

Benefits of LAM

• Provides protection against pregnancy for a maximum of 6 months

• Can be used immediately after childbirth

• Can be used by all women post partum

• Is under the control of the woman herself

Benefits of LAM

• Does not require supplies or procedures

• Is economical (free)

• Has no hormonal, or other, side effects

• Raises no religious objections

LAM attracts new FP Users

Study Site % (N) Never Used FP Prior to LAM

Egypt 71% (42)

Indonesia 84% (51)

Philippines 66% (31)

Mexico 58% (29)

Hight-Laukaran et al, Contraception 1997; 55: 337-346

Benefits of Exclusive Breastfeeding

1. Prevent neonatal and infant illness (diarrhea, respiratory infection)

2. Prevent neonatal and infant death (mortality)

3. Stimulates oxytocin release causing uterine contraction to reduce postpartum blood loss

LAM supports optimal breastfeeding behaviors

1. Allow newborn to breastfeed as soon as possible after birth

2. Breastfeed frequently, whenever the infant is hungry, both day and night

3. Breastfeed only for the first six months

LAM supports optimal breastfeeding behaviors

4. Continue breastfeeding even if the mother or the baby becomes ill

5. Avoid using bottles, pacifiers or other artificial nipples

6. The mother must have proper diet and intake of liquids to be able to breastfeed

India Tools: LAM Comic & IEC materials

Operationalizing LAM messages - Easier to understand, remember, & follow

Exclusive breastfeeding messages: Breast milk only, no other liquids or food breastfeed on demand, day and night

You only breastfeed your baby

• Adding other foods to the baby’s diet makes the baby suckle the breast less

• The mother will not produce as much breast milk

• With less breastfeeding the mother is more likely to ovulate

LAM Criteria

LAM Criteria

• When you begin menstrual bleeding you are fertile again

• You can get pregnant even if you continue to breastfeed

Your period has not returned

Your baby is less than 6 months old

LAM Criteria

• When your baby turns 6 months you may be fertile again because of initiation of supplementary foods

• You can get pregnant even if you continue to breastfeed

How can transition to other modern methods be facilitated?

Emphasizing timely transition

● Offer postpartum women

choice of all appropriate FP

methods during first PP visit

● During this and subsequent

visits, discuss what she will

use after LAM

● Encourage women to keep

breastfeeding after LAM

Transition to Another Method: An Essential Component of LAM

• LAM is a “gateway” to other modern methods of contraception

• LAM provides the couple time to decide on another modern method to use after LAM

Transition to Another Method: An Essential Component of LAM

How do you ensure that LAM facilitates transition?

• Another method should be started as soon as any one of the three LAM criteria is not met

• The woman should be counseled to decide on the method to which she should transition when LAM counseling is initiated

Why is Timely Transition So Essential?

Fertility May Return Soon after Delivery• If not breastfeeding, ovulation will occur at 45

days postpartum on average; may occur as early as 21 days

• Breastfeeding women not practicing LAM are likely to ovulate before return of menses

• Between 5% and 10% of women conceive within the first year postpartum

What are the advantages of waiting two years after having a baby to become pregnant again?

Benefits for the mother, baby & the family

Opportunities to Provide LAM Counseling and Integration

• Antenatal clinic• Child health (well-baby) clinic• Postpartum ward• Postpartum clinic• Immunization centres• Family planning clinic• Labor ward (during early labor or after birth)• Community health visits

Why is it important to integrate LAM in all health programs that serve pregnant and postpartum women?

• Has significant health benefits for both mothers and children

• Provides women with effective protection from pregnancy for up 6 months – a high risk period

• Can facilitate a timely transition to other family planning methods

Rationale for supporting LAM in FP & MNCH services

• LAM attracts many women who are not FP users

• Can serve as introductory / “gateway” FP method

• Contributes to health benefits of healthy timing and spacing of pregnancies

• Can support exclusive breastfeeding

Jharkhand, India: Integration in MoH and ICDS programs in select districts

MoHFW in FP programs:

Environment supportive of PPFP

Trg of all service providers including MOs, ANMs, LHVs

and CHWs on LAM

Printing of LAM client cards through Govt resources

Partially included in reporting format

Included in JSY (maternal health) card for pregnant

mothers

Jharkhand, India: Integration in ICDS program

Supportive environment for LAM as it encourages EBF which is a key intervention

Training of all service providers including AWWs, cluster coordinators, CDPOs and DPOs

Govt notification to all District Officers to support inclusion of LAM in the activities at Anganwadi Centres

Counseling on LAM to be given to all pregnant and lactating mothers

Case Studies:Case 1A mother comes to you four weeks after giving birth reporting that she has had 2 days of some bleeding. She is only breastfeeding her baby.

• Can this mother rely on LAM for contraception? - Yes she can rely on LAM for contraception

• Why? - Her spotting is part of the post partum bleeding and not return of menstruation- She meets the 3 criteria of LAM use

• What advice will you give to this mother?- She must continue to breastfeed her child at all times during day and night- To return to a health provider if any of the three conditions break

Case Studies: (contd)Case 2

Rita gives birth on Jan 7, 2010. Rita is following the 3 criteria's of LAM until she comes to you for advise. Her mother in law wants the baby to be given honey each evening.

• Will Rita be able to continue using LAM if she starts giving honey?- Rita will not be able to use LAM if she starts to give her baby any additional food or liquid before the baby turns 6 months old

• What advice will you give to Rita?- Rita must continue to ONLY breastfeed her baby while she

introduces supplementary food at 6 months only- Also talk to her mother In law to help her make the right choice for

the baby and Rita- Rita must start using a FP method when LAM is no longer effective

for her. Provide her options and advice.

Thank you!

Georgetown University Institute for Reproductive Health

www.irh.orgGeorgetown University

Institute for Reproductive Health, Indiahttp://www.irh.in/