Breastfeeding and child spacing : country profiles

The continuance of optimal breastfeeding while the mother is still amenorrheic is called the lactational amenorrhea method (LAM) of family planning (FP). Using data collected between 1990 and 1995 by the Demographic and Health Surveys (DHS) project in collaboration with the governments of each profile country, this study examines 27 country profiles in order to determine worldwide patterns in breastfeeding, the transition from the lactational amenorrhea method (LAM) of family planning (FP) to the acceptance of a complementary FP method, and the potential in each of the profile countries for using LAM as an FP method. Each of the 27 country profiles consists of four graphs that are accompanied by brief interpretive comments on breastfeeding and FP-related issues that may be amenable to program and policy change. Key findings are as follows. (1) Breastfeeding prevalence is very low in most of the profile countries. In 17 of the 27 countries, most women neither breastfeed exclusively nor begin introducing supplements at 6 months postpartum. (2) A very common early feeding pattern is to breastfeed with water supplements. This should be discouraged: introducing water supplements before 6 months contributes to infant morbidity and mortality and a return to fertility by the mother. (3) Policies, programs, and breastfeeding support systems that enable women to breastfeed at home, school, and work are essential to improving breastfeeding practices worldwide. (4) For 17 of the 27 countries, lactational amenorrhea/abstinence is the greatest contributor to fertility reduction. Encouraging exclusive breastfeeding is best done with messages stressing maternal as well as infant health benefits. (5) In 10 countries, FP use does not increase as the biological protection from full lactational amenorrhea declines. In 13 countries, FP use drops between months 9 and 12 postpartum; the timely introduction of postpartum FP is essential to ensure healthy child spacing. (6) Where breastfeeding rates are low and practices not optimal, the LAM can serve as an important tool for improving breastfeeding behaviors. LAM would benefit many couples and their children throughout most of the 27 countries studied here, particularly where the sustained breastfeeding rate is high and use of FP low.