Breastfeeding as a method of Birth Control: Lactation
Amenorrhoea Method
(A Type of N F P- Natural Family Planning Method.)
Introduction
This is the most common method of
contraception in the first six months after childbirth. Scientists have
recently designated this form of family planning as ‘Lactation Amenorrhoea Method’ or L.A.M. It is the use of
breastfeeding as a temporary family planning method. LAM provides natural
protection against pregnancy and encourages planning for initiation of
another method at the proper time.
Who will
get the Contraceptive Protection by breast feeding? Not all lactating
women are going to be protected against pregnancy. Only following group of
women are protected against pregnancy during breastfeeding period i.e. provided
a) Her baby
gets at least 85% of his or her feedings as breast milk, and she breastfeeds
her baby often, both day and night AND
b) Her menstrual periods have not returned since
childbirth , AND lastly,
c) Her baby is
less than six months old.
All these
three criteria should be fulfilled to achieve near 100% contraceptive effect of
breastfeeding. If a women keeps breastfeeding very often, her protection
from pregnancy may last even longer than stipulated six months and perhaps as
long as nine to twelve months or beyond after last childbirth. This is called extended use of LAM. Knowingly or unknowingly,
rural women enjoy the benefit of this method of extended
L.A.M. as LAM continue to offer contraception to some even beyond six
months. This is truer and often availed by Indian rural women. This is a type
of natural family planning and costs
nothing. Our nation therefore avoids several thousand unwanted births
annually by adopting extended LAM method. In this context
it may be pertinent to mention that a
mother should ideally breastfeed up to two years along with weaning at six
months followed by supplementary foods (partial breastfeeding).
Detailed criteria of LAM
As stated earlier to make
breastfeeding as a successful method of natural contraception the woman
concerned has to follow all the following criteria e.g.
1. She should
breastfeed at least six times during day
time and at least one preferably two
feeds at night without supplementing water or any other drink. This is what
is called exclusive breastfeeding. Author wonders how many urban women
will take the trouble to put her baby to breast two or three times in night.
LAM to be cent percent effective total feeding duration i.e. suckling time in
twenty four hours should be ideally above eighty minutes or more.
2. As soon as menstruation resumes after
childbirth she should commence some form of contraception because it is well known
that contraceptive efficacy of LAM is markedly reduced as menstruation resumes
after childbirth.
3. The
contraceptive efficacy fades markedly six month after childbirth in spite of
continued breastfeeding. Therefore, six
month age of infant is a landmark for initiation
of contraceptive even if menstruation do not resume.
Efficacy of LAM as contraceptive
LAM method of
contraception is about ninety eight
effective in preventing conception in first six months postpartum provided
the concerned woman remains amenorrhoeic (nonoccurrence of menstruation). How
reliable is breast feeding? The failure rate of LAM is up to two pregnancies
per 100 women in the first six months postpartum provided no supplementary food
is added to baby during this period. This means strict adherence to the policy
of exclusive
breastfeeding. Nevertheless, two percent failure rate is not uncommon
with other contraceptives too and no couple should raise their eyebrow on this
minimal failure rate.
Advantages of adopting LAM as Contraceptive:
1. Effectively
prevents pregnancy for at least first six months and this the period of
coverage may be longer if a woman keeps breastfeeding often, day and night.
2. Encourages
the mother to adopt standard breastfeeding patterns thus indirectly improves
health of infant. The couple and relatives should remember that breast milk
provides the healthiest food for the baby.
3. No direct
cost for family planning.
4. No question
of contraceptive related side effects.
5. No need to
do anything at time of sexual intercourse. Coitaly independent like Copper
IUDs. Does not interrupt the pleasure of sex in the midway as is common in
withdrawal method or condoms.
6. Protects
the baby from life-threatening diarrhea and protects the baby from other infectious
diseases such as measles and pneumonia (respiratory tract infections) by transmitting the mother’s immunities to the
baby through breast milk. In Indian context breast milk provides a natural
and highly effective panacea against fatal diarrhea of neonates and infants.
Disadvantages of LAM method of
contraception:
1. Effectiveness
after
six months is uncertain Inspite of continued breast feeding.
2. The words ‘exclusive
breastfeeding’ sounds simple but it requires considerable effort and dedication on the part the woman. Frequent
breastfeeding, though ideal may be inconvenient or impractical for some women,
especially working mothers.
3. Unlike
condoms, there is no protection against sexually transmitted Infections (STIs)
including HIV/AIDS. Thus if a woman is infected with HIV and if her partner
does not use condom during sexual intercourse she may transmit the HIV through
such unprotected sex. Therefore ideally partners of all HIV positive women
should use barrier methods of contraception during all sexual intercourses
though women can use female condom or newer cervical barrier devices (Leas
Shield, Fem Cap) which will be equally effective in prevention of STI. The
newer designs of female condom is claimed to be superior in STI prevention e.g.
Reddy Female Condom, V-Armour Female Condom, Panty Condom. F-C female condom,
Feminine condom (by Medtech Products). Breast milk, however can also can
transmit HIV virus to neonate though such chance again is little. Such
transmission of virus through breast milk is also applicable for Hepatitis B
virus which is also secreted in milk. Most of the credit of newer male and
Female condoms(Designer Condoms) goes
to “CONRAD”-an organization
dedicated to innovation and development of newer condoms including Spring laden
Condoms, Inspiral Condoms, Contoured condoms, Sensidot Condoms ,Flared
condoms, Glans-covering condoms, Oscillating condoms, Spiral Condoms, Glow-in-Dark condoms to name a few including invisible condoms(vaginal microbicides)
for use of female partners. .
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