Lactational Amenorrhea Method (LAM) : A critical yet underutilized element of maternal and infant...
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Transcript of Lactational Amenorrhea Method (LAM) : A critical yet underutilized element of maternal and infant...
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/