THE LACTATIONAL AMENORRHEA METHOD (LAM) - A POSTPARTUM INTRODUCTORY FAMILY-PLANNING METHOD WITH POLICY AND PROGRAM IMPLICATIONS

It is well accepted that breastfeeding contributes significantly to ch ild survival and child nutrition. Healthful child spacing is associate d with improved birth outcomes and maternal recovery. On a population basis, breastfeeding may contribute more to birth spacing than all fam ily planning use combined in many countries. However, while breastfeed ing does provide a period of infertility, until recently, there was no reliable way for an individual woman to capitalize on this lactationa l infertility for her own efficacious child spacing. The Lactational A menorrhea Method (LAM) is a new introductory family planning method th at simultaneously promotes child spacing and breastfeeding, with its o ptimal nutrition and disease preventive benefits for the infant. LAM, as it is called, is based on the utilization of lactational infertilit y for protection from pregnancy and indicates the time for the introdu ction of a complementary family planning method. LAM is recommended fo r up to six months postpartum for women who are fully or nearly fully breastfeeding and amenorrheic, and relies on the maintenance of approp riate breastfeeding practices to prolong lactational infertility, with the concomitant delay in menses return. A recent clinical trial confi rmed the theoretical 98% or higher effectiveness of the method and fie ld trials are demonstrating its acceptability. Nonetheless, some demog raphers and family planning organizations continue to debate its value . The development, efficacy, and sequelae of the method are presented using data from several studies by the authors.