Lactational Amenorrhoea and Modern Contraceptives Use among Nursing Women in Egypt 2003

OBJECTIVES

To evaluate the potential for Lactational Amenorrhoea Method (LAM) and passive LAM among women with children below 6 months in the 2003 Egypt Demographic Health Survey (2003 EDHS), to assess the determinants of amenorrhea, and to examine the association of exclusive breastfeeding and amenorrhea with using modern contraceptive methods among nursing mothers of children below 2 years, adjusting for other associated variables.

METHODS

Data from the 2003 EDHS was downloaded from the DHS website. A sub-sample of women fulfilling all the four criteria were selected: 1) women with last birth of children less than 2 years; 2) currently married; 3) not being sterilized; and 4) currently breast feeding their children. Accordingly, 1934 women entered into the statistical analysis, of them 629 had children below 6 months.

RESULTS

Nearly 24% of nursing mothers with children below 6 months met LAM criteria, of them passive LAM users constituted 79.1%. For women with children below 24 months, determinants of amenorrhea were exclusive breast feeding, unemployment, number of living children, husband education, number of feeding at night, and having a male sex child. Higher education, urban residence, positive attitude towards contraception increased the likelihood of modern contraceptives use, whereas amenorrhea, exclusive breast feeding, and having a wanted child decreased its likelihood in multivariate analysis.

CONCLUSION

Exclusive breast feeding was associated with amenorrhea and modern contraceptive methods use in a direct and inverse fashion respectively. LAM is a commonly used method but it is liable to discontinuation or violation of its criteria. Hence, it is recommended to educate both the health care providers and users about it.

Lactational amenorrhea is associated with child age at the time of introduction of complementary food: a prospective cohort study in rural Senegal, West Africa

BACKGROUND

In Africa, lactational amenorrhea is the major reason for birth spacing.

OBJECTIVE

We studied whether the early introduction of complementary food to infants is associated with an increased risk of menstruation resumption in rural African women.

DESIGN

Senegalese women (n = 855) were included at 2-3 mo postpartum and followed up at 4-5 and 6-7 mo in dispensaries. A subsample of 502 women were followed up at 9-10 mo and twice yearly at home thereafter. Risk factors for menstruation resumption were assessed with logistic regression, with control for maternal parity, occupation, education, postpartum body mass index, child sex and weight-for-age, and season.

RESULTS

The risk of menstruation resumption was 4.2% (95% CI: 2.8%, 5.6%) at 6-7 mo and 6.5% (4.0%, 8.9%) at 9-10 mo. Compared with the introduction of complementary food after 6-7 mo, introduction at 2-3, 4-5, or 6-7 mo was associated with a greater odds of menstruation resumption at 6-7 mo [odds ratios (ORs): 5.08 (1.01, 25.5), 6.00 (1.29, 27.4), and 4.45 (0.96, 20.6; NS), respectively]. Introduction of food at 4-5 or 6-7 mo compared with that after 6-7 mo was associated with significantly greater odds of menstruation resumption at 6-7 mo (5.13; 1.16, 22.6) but not at 9-10 mo (3.07; 0.65, 14.4; NS) or year 2.

CONCLUSION

Child age at introduction of complementary food was significantly associated with the odds of menstruation resumption at 6-7 mo postpartum.

Is breast-feeding a substitute for contraception in family planning?

Using data from the Cebu Longitudinal Health and Nutrition Survey, I disentangle the complex interrelationship between breast-feeding, postpartum amenorrhea, and choice of contraceptive method. I find evidence that women substitute breast-feeding for contraception. Further, endogeneity bias, if not controlled, would cause the relationship to be slightly overstated. In addition, the results suggest that although increased education and income result in decreased breast-feeding, any effect on fertility will be offset by changes in contraceptive use.

Maternal nutritional status is inversely associated with lactational amenorrhea in Sub-Saharan Africa: results from demographic and health surveys II and III

Breast-feeding is positively associated with the duration of postpartum amenorrhea; thus it is a major determinant of fertility in countries where effective contraceptive methods are not widely available. The objective of these analyses was to examine the association between maternal nutritional status and lactational amenorrhea (LA) among breast-feeding women. Women who were not pregnant, who were breast-feeding, who were not using hormonal contraceptives and who had a child </=2 y old at the time of survey were included in the analyses. Multivariate logistic regression was used to examine this association with the use of Demographic and Health Surveys data collected in seven Sub-Saharan African countries between 1990 and 1994. Analyses were adjusted for nine confounders, including breast-feeding behavior, child nutritional status and child age. Within-country analyses consistently showed the trend of low maternal body mass index (BMI) associated with a higher likelihood of being amenorrheic. Pooled analyses (n = 9839) were performed using two child age groups (<9 mo and 9-24 mo). The <9 mo pooled analysis showed that women with BMI < 18.5 kg/m2 (odds ratio; 95% confidence interval: 1.6; 1.2-2.3) were more likely to remain amenorrheic at the time of the survey than their "better-nourished" counterparts. The 9-24 mo pooled analysis showed that the differential probability of being amenorrheic between undernourished and "better-nourished" women increased with time postpartum, where the adjusted difference in the median duration of amenorrhea associated with maternal 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.

Multicenter study of the Lactational Amenorrhea Method (LAM): I. Efficacy, duration, and implications for clinical application

A multicenter study of the Lactational Amenorrhea Method (LAM) was carried out to test the acceptability and efficacy of the method. Additionally, the data are used to test new constructs for improvement of method criteria. A protocol was designed at the Institute for Reproductive Health (IRH), Department of Obstetrics and Gynecology, Georgetown University Medical Center, a World Health Organization (WHO) Collaborating Center, and was reviewed and modified in collaboration with the co-sponsors, the World Health Organization and the South to South Cooperation for Reproductive Health, and the principal investigators from each site. Data were gathered prospectively on LAM acceptors at 11 sites. Data were entered and cleaned on-site and further cleaned and analyzed at IRH, using country-level and pooled data to produce descriptive statistics and life tables. The 98+% efficacy of LAM is confirmed in a wide variety of settings. In addition, the results yield insight on the possibility of continued use beyond 6 months. LAM is found to be highly effective as an introductory postpartum method when offered in a variety of cultures, health care settings, socio-economic strata, and industrial and developing country locales. In addition, LAM acceptance complements breastfeeding behaviors without ongoing breastfeeding support services. The parameters studied yield high efficacy and method continuation. Therefore, the basic tenets of the 1995 Bellagio consensus on LAM is reconfirmed and it is recommended that LAM be reconfirmed and it is recommended that LAM be incorporated into hospital, maternity, family planning, maternal and child health, and other primary health care settings.

Dies endogeneity matter? A comparison of empirical analyses with and without control for endogeneity

PURPOSE

Using data from the Cebu Longitudinal Health and Nutrition Survey, we perform an empirical investigation of the effects of endogeneity and unobserved heterogeneity in the analysis of health outcomes.

METHODS

First, we lay a theoretical background for this analysis and develop a set of expectations regarding the effects of ignoring endogeneity. Then, by modeling the effect of infant-feeding patterns on time to resumption of menses, we perform parallel analyses with and without control for endogeneity.

RESULTS

We show that in this analysis, as far as the effects of endogeneity are concerned, empirical results do accord with theoretical expectations. There are differences in parameter estimates between models, that lead to somewhat different interpretations.

CONCLUSIONS

We discuss the importance and implications of these findings for epidemiological studies of health outcomes. We outline the steps involved in such an analysis and discuss the practical limitations of the methods, as well as the possible gains.