MATERNAL NUTRITIONAL-STATUS IS INVERSELY ASSOCIATED WITH LACTATIONAL AMENORRHEA IN SUB-SAHARAN AFRICA - RESULTS FROM DEMOGRAPHIC AND HEALTHSURVEY-II AND SURVEY-III

Breast-feeding is positively associated with the duration of postpartu m amenorrhea; thus it is a major determinant of fertility in countries where effective contraceptive methods are not widely available. The o bjective of these analyses was to examine the association between mate rnal nutritional status and lactational amenorrhea (LA) among breast-f eeding women. Women who were not pregnant, who were breast-feeding, wh o were not using hormonal contraceptives and who had a child less than or equal to 2 y old at the time of survey were included in the analys es. Multivariate logistic regression was used to examine this associat ion with the use of Demographic and Health Surveys data collected in s even Sub-Saharan African countries between 1990 and 1994. Analyses wer e adjusted for nine confounders, including breast-feeding behavior, ch ild nutritional status and child age. Within-country analyses consiste ntly showed the trend of low maternal body mass index (BMI) associated with a higher likelihood of being amenorrheic. Pooled analyses (n = 9 839) were performed using two child age groups (<9 mo and 9-24 mo). Th e <9 mo pooled analysis showed that women with BMI < 18.5 kg/m(2) (odd s ratio; 95% confidence interval: 1.6; 1.2-2.3) were more likely to re main amenorrheic at the time of the survey than their ''better-nourish ed'' counterparts. The 9-24 mo pooled analysis showed that the differe ntial probability of being amenorrheic between undernourished and ''be tter-nourished'' women increased with time postpartum, where the adjus ted difference in the median duration of amenorrhea associated with ma ternal nutritional status among breast-feeding women was 1.4 mo. These results suggest that maternal nutritional status plays an independent role in the return of ovulation after delivery.