THE WORLD-HEALTH-ORGANIZATION MULTINATIONAL STUDY OF BREAST-FEEDING AND LACTATIONAL AMENORRHEA - I - DESCRIPTION OF INFANT-FEEDING PATTERNSAND OF THE RETURN OF MENSES

Objective: To detect differences between populations in both infant fe eding practices and the duration of lactational amenorrhea, if they ex ist. Design: Prospective, nonexperimental, longitudinal follow-up stud y. Setting: Five developing and two developed countries. Patient(s): F our thousand one hundred eighteen breast-feeding mothers and their inf ants. Intervention(s): Breast-feeding women collected ongoing informat ion about infant feeding and family planning practices, plus the retur n of menses. Fortnightly follow-up occurred in the women's homes. Main Outcome Measure(s): Breast-feeding frequency by day (and by night); 2 4-hour breast-feeding duration, percent of all infant feedings that we re milk/milk-based (and solid/semisolid foods); time until the end of full breast-feeding; time until regular supplementation; and time unti l the end of lactational amenorrhea. Result(s): Differences between th e centers in the duration of amenorrhea were substantial, ranging from a median of 4 months in New Delhi (India) to 9 months in Chengdu (Chi na). Women in developed countries (but also women in Chengdu) were mor e likely to delay supplementation (for up to 5 months), whereas women in Santiago (Chile), Guatemala City (Guatemala), and Sagamu (Nigeria) started supplements much earlier, sometimes as early as 1 week after b irth. Conclusion(s): Both breast-feeding behavior and the duration of lactational amenorrhea vary markedly across settings, indicating that breast-feeding promotion and family planning advice should be site- an d culture-specific. (Fertil Steril(R) 1998;70:448-60. (C)1998 by Ameri can Society for Reproductive Medicine.).