Your search found 58 Results
Controversies in postpartum contraception: when is it safe to start oral contraceptives after childbirth?
Thrombosis Research. 2011; 127(Suppl 3):S35-S39.The timely initiation of contraception postpartum is an important consideration for breastfeeding and non-breastfeeding women; many women prefer oral contraceptive pills to other methods. In breastfeeding women, combined hormonal pills are not recommended prior to 6 weeks postpartum, due to effects on milk production. Although progestogen-only pills do not adversely affect milk, lack of data regarding possible effects on infants exposed to progestogens in breast milk renders timing of initiation of this method controversial. In non-breastfeeding women, elevated risk of venous thromboembolism restricts use of combined hormonal pills prior to 21 days postpartum. From 21 to 42 days, use of combined hormonal pills should be assessed based on a woman's personal venous thromboembolism risk profile; after 42 days postpartum there is no restriction in the use of combined hormonal pills for otherwise healthy women. Non-breastfeeding women may safely use progestogen-only pills at any time during the postpartum.
An evidence-based approach to postpartum use of depot medroxyprogesterone acetate in breastfeeding women.
Contraception. 2009 Jul; 80(1):4-6.This article reviews the evidence and safety of immediate depot medroxyprogesterone acetate (DMPA) use in lactating postpartum women. It presents the benefits for mothers and infants, the concerns, the safety issues, and states that existing data are not sufficient to limit DMPA use postpartum in women at high risk for unintended pregnancy.
The World Health Organization multinational study of breast-feeding and lactational amenorrhea. II. Factors associated with the length of amenorrhea.
Fertility and Sterility. 1998 Sep; 70(3):461-471.The objective was to determine the relation between infant feeding practices (and other factors) and the duration of postpartum amenorrhea, and to establish whether there are real differences in the duration of postpartum amenorrhea for similar breast-feeding practices in different populations. Design: Prospective, nonexperimental, longitudinal follow-up study. Setting: Five developing and two developed countries. Patient(s): Four thousand one hundred eighteen breast-feeding mothers and their infants. Breast-feeding women collected ongoing information about infant feeding and family planning practices, plus the return of menses. Fortnightly follow-up occurred in the women's homes. A multivariate analysis explored the association between the risk of menses return and 16 infant feeding variables and 11 other characteristics. Ten factors (in addition to center effects) were significantly related to the duration of amenorrhea. Seven of these were infant feeding characteristics and the remaining three were high parity, low body mass index, and a higher frequency of infant illness. The breast-feeding stimulus is strongly linked to the duration of postpartum amenorrhea. Cross-cultural effects also are extremely important and may have caused the variations in feeding, the variation in amenorrhea, or both. (author's)
Contraception. 2003 Oct; 68(4):233-238.Contraception choices may be limited for lactating women due to concerns about hormonal effects on quality and quantity of milk, passage of hormones to the infant and infant growth. We conducted a systematic review of randomized controlled trials to determine the effect of hormonal contraception on lactation. We sought all randomized controlled trials, reported in any language, that included any form of hormonal contraception compared with another form of hormonal contraception, nonhormonal contraception or placebo during lactation. Seven reports from five randomized controlled trials met the inclusion criteria. Most of the five trials did not specify their method used to generate a random sequence, method of allocation concealment, blinding of treatments or use of an intention-to-treat analysis. Additionally, high loss-to-follow-up rates invalidated at least two trials. The findings from two trials comparing oral contraceptives to placebo during lactation were conflicting. Another trial found no inhibitory effects on lactation from progestin-only contraceptives. Finally, the World Health Organization trial found a statistically significant decline in breast milk volume in women using combined oral contraceptives compared to women using progestin-only pills. However, infant growth for the two groups did not differ. The limited evidence from randomized controlled trials on the effect of hormonal contraceptives during lactation is of poor quality and insufficient to establish an effect of hormonal contraception, if any, on milk quality and quantity. At least one properly conducted randomized controlled trial of adequate size is urgently needed to make recommendations regarding hormonal contraceptive use for lactating women. (author's)
WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1985; (724):1-206.In 1981, participants in the Joint FAO/WHO/UNU Expert Consultation on Energy and Protein Requirements met in Italy to reexamine the interrelationships between energy and protein requirements and to recommend methods to integrate requirement scales for energy and proteins. They stated that the use of a reference man or woman to determine energy requirements should no longer be used since it is unduly restrictive and there is a wide range of body size and patterns of physical activity. The tables exhibit this wide range so users can use those values that best apply to his or her conditions. Overall the participants agreed that estimates of energy requirements should be based on actual or desirable energy requirement estimates. In terms of children, however, this principle cannot be applied since there is not enough information available about their energy expenditure. Further no one could agree on how to determine what actual intakes are needed to maintain health in its broadest sense in either developing or developed countries since observed actual intakes are not necessarily those that maintain a desirable body weight or optimal levels of physical activity. Divers patterns of physical activity in different age and sex groups are presented nonetheless to guide users in applying requirement estimates. The maintenance protein requirements identified by the 1971 consultation for the young child < 6 years old, e.g. 1 g/kg.day for 5-6 year old, and the young male adult (.54-.99 g.kg/day) remained the same. The participants made indirect estimates of protein needs for the remaining age and sex groups. They acknowledged that digestibility can affect the availability of protein and protein requirements need to be adjusted for fecal losses of nitrogen. They concluded that the natural diets for infants and preschool children contain sufficient amount of essential amino acids, but not those of the remaining groups.
Contraception. 1984 Dec; 30(6):505-22.The World Health Organization (WHO) conducted a randomized comparative trail of th effects of hormonal contrception on milk volume and infant growth. The 341 study participants, drawn from 3 obstetric centers in Hungary and Thailand, were 20-35 years of age with 2-4 live births and previous successful experience with breastfeeding. Subjects who chose oral contraception (OC) were randomly allocated to a combined preparation containing 150 mcg levonorgestrel and 30 mcg ethinyl estradiol (N=86) or to a progestin-only minipill containing 75 mcg dl-norgestrel (N=8). 59 Thai women receiving 150 mg depot medroxyprogesterone (DPMA) intramuscularly every 3 months were also studied. An additional 111 women who were using nonhormonal methods of contraception or no contraception served as controls. Milk volume was determined by breast pump expression. No significant differences in average milk volume were noted between treatment groups at the 6 week baseline visit. However, between the 6th and 24th weeks, average milk volume in the combined OC group declined by 41.9%, which was significantly greater than the declines of 12.0% noted in the progestin-only group, 6.1% among DMPA users, and 16.7% among controls. The lower expressed milk volume among combined OC users did not impair infant growth. No significant differences were observed between treatment groups in terms of average infant body weight or rate or weight gain. Users of combined OCs may have compensated for their decreased milk volume by providing more extensive supplementary feeding or more prolonged suckling episodes. These results suggest that the estrogen content of combined OCs adversely affects the capacity of the breast to produce milk; thus, family planning programs should make nonestrogen-containing methods available to breastfeeding mothers. Although no effects on infant growth were noted in this study, the possibility of such efects cannot be excluded in populations where infant growth largely depends on the adequacy of unsupplemente d lactation.
Geneva, Switzerland, WHO, 1981. 76 p. (WHO Technical Report Series No. 657)This report on the effect of female sex hormones on fetal health and development aimed to evaluate research on the specific types of sex hormones and their uses, to determine their safety with respect to fetal development and infant health, and to recommend further research in these areas. Theoretically, sex hormones can affect any stage of fetal development. Sex hormones appear to act by promoting synthesis of messenger ribonucleic acid (mRNA) in target tissues, so that research should focus on the specific proteins formed under the direction of newly synthesized mRNA to elucidate potential morphological and physiological effects of exogenous hormones. Following are some research avenues: cytogenetic research, microscopic and macroscopic examination, observations on births and later life, animal teratology, and epidemiological studies. Epidemiological studies not only help elucidate causal associations but also provide public health data. Studies of sex hormones and fetal development and infant health must be free of bias and often suffer from problems of defining pregnancy outcome. Also sex steroids are frequently administered at the same time as other drugs, leading to confounding effects of drug interactions. In order to assess existing data, it is necessary to disaggregate the data from different reports and then to regroup them according to the indications for use, i.e., infertility, contraception, pregnancy testing, supportive therapy during pregnancy, contraception during pregnancy, contraception during breast feeding. Likewise data must be disaggregated according to different types of exposure, i.e., preconception or postconception. The bulk of this monograph is spent disaggregating study data based on the above-stated rationales. The following recommendations are made for indications for use of sex hormones: 1) they should not be used as pregnancy tests; 2) diethylstilbestrol should not be prescribed to a suspected pregnant woman; 3) benefits of progestin therapies must first be proven before they can be recommended for use in supporting pregnancy; 4) oral contraceptives given before pregnancy seem to have no effect on subsequent pregnancy; and during lactation combined therapy should not be given.
Geneva, WHO, 1976. (WHO Technical Report Series No. 600) 98 p.Approximately 125 million infants were born in 1975 and approximately 10-12 million died before their first birthday. The WHO Expert Committee on Maternal and Child Health met in Geneva December 9-15, 1975 to consider new approaches and trends in delivering maternal and child care health services. The Committee decided to redefine health problems and adapt delivery of services in light of social and environmental changes. The effect of careful and informed mothering on the health of the entire family and the relation of family health to community health are important factors in individual, national, and community development. The roles of environmental and socioeconomic factors in mortality, morbidity, and growth and development have been further clarified during the last decade. In countries where data was not previously available, the mmultiple causation of the main health problems of mothers and children has been better documented. The priority health problems are related to the synergistic effects of malnutrition, infection, and unregulated fertility, together with poor socioeconomic conditions and scarcity of health services.
World Health Organization, (Technical Report Series.). 1965; 22.A report of the Scientific Group on the Physiology of Lactation which met in Geneva, December 2-7, 1963, is presented. Major aspects covered include: 1) growth of the mammary gland; 2) milk secretion; 3) biochemical activities of the mammary gland; 4) the physiology of suckling; and 5) factors of human lactation and breast feeding. It is recommended that WHO should: 1) provide grants and research fellowships to enable research workers in the field of lactation to extend their experience by working for a time in other appropriate research centers; 2) support the establishment of laboratories in certain countries for the titration of hormones in cases of normal and abnormal lactation; 3) make contact with organizations engaged in the collection of primate pituitary tissues to obtain their advice and help in organizing the extension of the collection to other parts of the world and in arranging for the preparation of extracts, especially of human prolactin and somatotrophin for international use; 4) make contact with individuals and organizations engaged in the collection of hypothalamic tissue with the object of improving facilities for collection; and 5) encourage studies on human lactation in relation to malnutrition and undernutrition in developing countries.
Geneva, World Health Organization, 1964. (Technical Report Series No. 280.) 30 p.A WHO Scientific Group on the Biology of Human Reproduction was convened in Geneva from April 2-8, 1963, for the purpose of advising the Director-General on developments and major research needs in that field. The biology of human reproduction is an extremely broad scientific topic, which impinges to some degree on virtually all the basic medical disciplines. Major topics included in the report are: 1) comparative aspects of reproduction; 2) neuroendocrine aspects of reproduction; 3) biology of the gonads and gametes; 4) gestation; 5) biochemistry of the sex steroids; 6) immunological aspects of reproduction; and 7) pharmacological aspects of reproduction. The Group recommends: 1) that WHO assist in the development of fundamental knowledge of the biology of human reproduction and of other fields on which that knowledge is based and 2) that WHO convene meetings of appropriate specialist groups to consider practical methods of implementing certain proposals concerning organization of surveys, provision of services, and promotion of relevant research.
In: Annual technical report, 1992, [of the] World Health Organization [WHO]. Special Programme of Research, Development and Research Training in Human Reproduction. Geneva, Switzerland, WHO, 1993. 95-106. (WHO/HRP/ATR/92/93)This 1992 Annual Report of the Task Force on the Natural Regulation of Fertility of the World Health Organization's Special Programme of Research, Development, and Research Training in Human Reproduction describes the principal objectives of the Task Force as 1) improving understanding of the mechanisms and factors that influence the duration of lactational infertility, 2) developing and evaluating methods to detect ovulation, and 3) improving and evaluating the effectiveness of natural family planning methods based on periodic abstinence. In the area receiving most of the Task Force's attention, three research lines are being supported to determine 1) the relationship between breast-feeding practices and the duration of lactational amenorrhea, 2) the biological mechanisms of ovarian suppression during lactation, and 3) the "interface" between relying on lactation for fertility regulation and the use of other methods. Ovulation detection research includes 1) a multicenter study to assess whether women can measure changes in cervico-vaginal fluid volume with a simple device to identify the fertile period and 2) evaluation of methods for home-based assays of urinary estrone and pregnanediol glucuronides to monitor cyclical changes. In the area of natural family planning, preparations are being made to conduct research into the calendar/rhythm methods commonly used. The Task Force works in close collaboration with the international organizations which are active in the field and distributes information about Task Force activities through scientific publications and conferences.
Breastfeeding management and promotion in a baby-friendly hospital: an 18-hour course for maternity staff.
New York, New York, UNICEF, 1993 Jan. , vii, 127,  p.The Baby Friendly Hospital Initiative seeks to promote exclusive breast feeding in the first 4-6 months of life, followed by supplemental feeding up to two years of age or beyond. To assist hospitals in making the policy changes necessary for achieving this goal, an 18-hour course for physicians, midwives, nurses, and other maternity staff was devised. The curriculum was designed to impart the knowledge required to implement the 10 steps to successful breast feeding: 1) develop a written breast feeding policy, 2) train all health care staff in skills needed for policy implementation, 3) inform all pregnant women about the benefits and management of breast feeding, 4) help mothers initiate breast feeding within 30 minutes of delivery, 5) show mothers how to breast feed and maintain lactation when separated from their infant, 6) give newborns no food or drink other than breast milk unless medically necessary, 7) allow mothers and infants to remain together in the hospital, 8) encourage demand feeding, 9) provide no pacifiers, and 10) promote the establishment of breast feeding support groups. In addition to the 14 lessons that comprise this manual, the course includes three hours of clinical experience.
In: Natural family planning: current knowledge and new strategies for the 1990s. Proceedings of a conference, Part II, Georgetown University, Washington, DC, December 10-14, 1990, edited by John T. Queenan, Victoria H. Jennings, Jeffrey M. Spieler, Helena von Hertzen. [Washington, D.C.], Georgetown University, Institute for International Studies in Natural Family Planning, . 9.The World Health Organization has two sections which work in the field of natural family planning: the Division of Family Health through its Maternal and Child Health and Family Planning Program (MCH), and the Special Program of Research, Development, and Research Training in Human Reproduction (HRP) through its Task Force on methods for the Natural Regulation of Fertility. The MCH focus upon education and services complements the HRP's efforts in biomedical research. The long-term objective of task force research is to improve the performance of methods used for NFP. The main research areas are lactation, indices of the fertile period, and NFP, with primary emphasis given to lactation and its contribution to the natural suppression of fertility. Lactation is receiving high priority because breastfeeding makes an important contribution to infant and maternal health, and to birth spacing. Moreover, breastfeeding is the only form of birth spacing available to many women in the developing world.
MOTHERS AND CHILDREN. 1994; 13(1):5.As part of an ongoing effort to halt the decline of breast feeding rates in Africa, 35 representatives of 12 different African countries met in Mangochi, Malawi, in February 1994. The Code of Marketing of Breastmilk Substitutes was scrutinized. National codes were drafted based on the "Model Law" of the IBFAN Code Documentation Centre (ICDC), Penang. Mechanisms of implementation, specific to each country, were developed. Strategies for the promotion, protection, and support of breast feeding, which is very important to child survival in Africa, were discussed. The training course was organized by ICDC, in conjunction with IBFAN Africa, and with the support of the United Nations Children's Fund (UNICEF) and the World Health Organization (WHO). Countries in eastern, central, and southern Africa were invited to send participants, who included professors, pediatricians, nutritionists, MCH personnel, nurses, and lawyers. IBFAN Africa has also been conducting lactation management workshops for a number of years in African countries. 26 health personnel (pediatricians, nutritionists, senior nursing personnel, and MCH workers), representing 7 countries in the southern African region, attended a training of trainers lactation management workshop in Swaziland in August, 1993 with the support of their UNICEF country offices. The workshop included lectures, working sessions, discussions, and slide and video presentations. Topics covered included national nutrition statuses, the importance of breast feeding, the anatomy and physiology of breast feeding, breast feeding problems, the International Code of Marketing, counseling skills, and training methods. The field trip to a training course covering primary health care that was run by the Traditional Healers Organization (THO) in Swaziland was of particular interest because of the strong traditional medicine sector in many African countries. IBFAN Africa encourages use of community workers (traditional healers, Rural Health Motivators, Village Health Workers, Mother Support Groups) to promote breast feeding.
The promotion of the lactational amenorrhea method and child spacing through breastfeeding advocates, Contract No. OR-HO-001.
[Unpublished] . vii, 44 p. (HON-05)In Honduras, a decreasing prevalence of exclusive breast feeding, with over 50% of infants given supplemental liquids during the first 30 days, was causing health risks for the infants and pregnancy risks for the mothers (with 49% at risk within a year of giving birth). Therefore, La Leche League Honduras (LLLH) conducted an operations research study in the Las Palmas neighborhoods of San Pedro Sula to evaluate whether the combination of medical personnel and mother support groups trained in lactation and the lactational amenorrhea method (LAM) for child spacing would increase prevalence and duration of exclusive breast feeding, amenorrhea, and the reported use of LAM at 6 months postpartum over that found in a community served only by trained medical personnel. This project received financing in the amount of US $20,250 from Georgetown University and technical assistance from the Population Council. Specific objectives were to train at least 50 physicians, provide updated information to at least 50 nurses through a workshop, train and certify at least 36 community mothers to serve as breastfeeding advocates (BAs) with specific information on LAM and the ability to make referrals to complementary family planning (FP) services, and initiate at least 6 mother support groups which would meet monthly throughout the year-long study period of 1991. A nonequivalent pre/post-test design was used with the experimental group receiving BA training and support groups and both the control and experimental groups receiving identical training of medical staff. A July 1990 survey of the 6,794 households in the project area revealed 1083 mothers of babies less than a year old and 630 pregnant women. 848 women from this group were interviewed at baseline and 922 at endline to determine socioeconomic status, health system affiliation, reproductive history, breastfeeding and infant feeding practices, contraceptive use, and LAM knowledge and attitudes. Focus groups were held after 3 months of service delivery for qualitative evaluation, interviews were conducted, and 4 mother support groups were observed. BAs were given record-keeping forms, and referral stubs were collected. This report described the implementation of project activities and the impact of the intervention in great detail. The results suggest that training health professionals was partially successful in improving breastfeeding practices and that use of LAs was effective in promoting exclusive breast feeding and use of compatible FP methods and increasing LAM knowledge. However, analysis of women using LAM as a FP method revealed that only 6.5% correctly met all criteria. Lessons learned from this evaluation are cited and the following suggestions are made for further research: 1) develop materials to teach LAM to low-literacy women; 2) examine the role of provider bias and influence of exclusive breast feeding prevalence on LAM acceptance; 3) discover the relative effectiveness of LAM promotion by LLLH vs. FP agencies; 4) test the effectiveness of strategies which segment a target population for LAM education; and 5) determine whether LAM leads to subsequent use of other FP methods.
JOURNAL OF BIOSOCIAL SCIENCE. 1992 Jul; 24(3):379-81.WHO Simplified Methodology (1987) is being applied in several studies: the Task Force on Methods for the Natural Regulation of Fertility of the Special Program on Human Reproduction in centers in Chendu, China; Guatemala City, Guatemala; New Delhi, India; Sagamu, Nigeria; Santiago, Chile; Uppsala, Sweden; and Westmead/Sydney, Australia. 550 lactating mothers who can read and write were examined in order to provide a better understanding of the relationship between breast-feeding duration and lactational amenorrhea, and to determine whether the longitudinal study results are applicable to the general population. Protocol involved data collection of breast-feeding frequency, timing, and duration; supplementary feeding characteristics and timing; and maternal and infant health. WHO protocol is also being examined in studies in Colombo, Sri Lanka, and Sagamu, Nigeria. The study objective was to examine the effect of maternal nutritional supplementation with skimmed milk powder in Colombo and a high protein biscuit in Sagamu on the duration of lactational amenorrhea in moderately malnourished breast-feeding mothers. Followup studies are expected. Optimally, the end product should be a measure of the presence of ovulation, however, the logistics prevented this from occurring. Instead, weekly urine samples were collected and tested for the presence of estrogen and pregnanediol glucuronide. Motivation is a key determinant in the success of these projects, since detailed record keeping over a prolonged period of time is required. Motivational interventions vary between centers and may involve social contact with investigators or health care support for the mother and infant. Some preliminary results indicate that the higher the percentage receiving supplementation, the earlier the return of the menses.
Washington, D.C., World Bank, 1989. 55 p. (World Bank Technical Paper No. 102)After a brief explanation of the impact of breastfeeding on fertility worldwide, inaccurate assumptions about the decline of breastfeeding are explored to point out the need for renewed promotion of breastfeeding by World Bank projects. Breastfeeding, by inhibiting fertility through lactational anovulation, is one of the most important determinants of fertility, especially for 83% of couples in developing countries who do not use modern contraception. Many believe that breastfeeding does not need promoting in areas where it is the norm, yet this belief does not take into account the need for supporting breastfeeding women, teaching them to breastfeed exclusively and frequently for the 1st 4 months. The belief that declines in breastfeeding are inevitable is belied by recent evidence in developed countries. The reliability of breastfeeding as a contraceptive for individual women varies: poor, undernourished women who breastfeed extensively may be protected up to 21.7 months (Bangladesh). Advantages of breastfeeding include significant savings of money, foreign exchange, scarce contraceptive supplies, medical treatment of diarrhea and malnutrition in infants, and possibly mothers' time. In contrast, other caregivers can prepare milk substitutes, but breastfeeding can be encouraged in the work setting, or milk expressed for later use. A review of 68 World Bank Projects revealed that 37% of all Population, Health and Nutrition projects, enumerated in an appendix, contained explicit actions to promote breastfeeding. 10 recommendations for promoting breastfeeding end the report.
London, England, International Planned Parenthood Federation, 1990. 122 p. (IPPF Medical Publications)This booklet intended for family planning doctors primarily in developing countries updates the previous IPPF edition, with new information on oral contraceptives, chapters on the subdermal implant Norplant, post-coital contraception, injectables, and appendices on statistical methods and post-partum contraception. Each chapter contains text with a statement by the IMAP (International Medical Advisory Panel) of the IPPF. After brief introductions on historical background and reproductive physiology, the main part of the book concerns the use of combined oral contraceptives, their actions, beneficial and adverse effects, indications and contraindications, and several aspects of use such as community-based distribution. There are chapters on progestogen-only pills and on orals in chronic disease. Post-coital contraception is discussed, considering combined pills, progestagens, IUDs, Danazol, RU-486, which all have different time limits of effectiveness. Both DMPA and NET-EN injectables, by 3-month and monthly protocols are described, with a section on the controversy regarding their distribution. The chapter on Norplant comprises mostly the IMAP statement: more information would be needed for training in this method. The book ends with remarks on the use of hormonal contraceptives to enhance safe motherhood, taking into account the fact that the pill offers no protection against STDs.
IPPF MEDICAL BULLETIN. 1990 Apr; 24(2):2-4.The International Planned Parenthood Federation International Medical Advisory Panel drew up the following statement in November, 1989. Breastfeeding is good for the infant. Antibodies passed to it from the mother protect it from infection. Patterns of breastfeeding are changing. Therefore, the risk of pregnancy is increased. Postpartum amenorrhea plays a major role in natural fertility regulation. Studies from around the world show a positive correlation between the length of breastfeeding and the length of lactational amenorrhea. Amenorrhea lasts longer in those who breastfeed more often at night and during the day. There is controversy over the effect of nutrition on postpartum infertility. Pregnancy and the puerperium are a good time for counseling on maternal nutrition, child spacing, breastfeeding, and contraceptive methods. Counseling nursing mothers about potential fertility during lactation should be based on local information. All women should be advised to fully breastfeed. Family planning programs should cooperate with maternity services in providing counseling and education for postpartum women who need contraception, for providing referral services, for producing educational resources, and in training health personnel. Postpartum contraception should be included in the training of traditional birth attendants. Women who do not breastfeed can select any contraceptive method. Mothers who nurse must not hurt success of lactation or the infant's health. Nonhormonal contraception should be the 1st choice for lactating women. IUDs do not harm infant growth or lactation. Postpartum insertions are appropriate, though care must be taken. Female sterilization can be conveniently done at this time. Barrier methods are reliable when used regularly. The failure rate should be lower when used after delivery. Progestagen-only contraception consists of progestagen-only pills, injectables, and Norplant. These do not affect quality and quantity of breast milk or length of lactation. They are suitable for those who do not wish nonhormonal methods. There are possible consequences, however, of the transfer of the steroid to breast milk. Hormonal methods should not be used earlier than 6 weeks postpartum. High and low dose oral contraceptives adversely affect the quality and quantity of breast milk. They also reduce duration of lactation. They should be withheld until 6 weeks after delivery, or until the infant is weaned--whichever comes first. The efficacy or periodic abstinence in nursing women requires further analysis.
In: Advances in international maternal and child health. Volume 7. 1987, edited by D.B. Jelliffe and E.F.P. Jelliffe. Oxford, England, Clarendon Press, 1987. 170-9.General principles of the WHO Essential Drug List (EDL) and the International Non-Proprietary Names (INN) list and their application to maternal and child health are summarized. 8 principles of good prescribing habits are introduced, such as careful dosing for infants, children, pregnant or lactating women, elderly, or those with liver or kidney disease. Most INN drug names are identical to the generic names used in the country of origin, but some are coined from common chemical or pharmacological stems. Drugs for pregnant women should be limited in number, and used with care since almost all cross the placenta and may not be tolerated by the fetus with its immature liver and kidneys. The most serious reason for restricting certain drug intake by pregnant women is the risk of teratogenicity, particularly in the 1st trimester. Potential teratogens include antiepileptics, barbiturates, cytotoxics, anticoagulants, and female sex hormones. Salicylates should not be taken near term. Opioid analgesics should not be used during labor. Drugs dangerous for the infant during breastfeeding include high dose oral contraceptives, the antithyroid drugs thiouracil and iodine, diazepam and lithium. Education and training in pharmacokinetics for personnel in maternal-child health should be included. Fixed combinations of drugs are not advisable: out of 220 drugs in the EDL, there are only 11 drug combinations.
In: Programmes to promote breastfeeding, edited by Derrick B. Jelliffe and E. F. Patrice Jelliffe. Oxford, England, Oxford University Press, 1988. 235-47.The work of the WHO in promoting, monitoring, researching, and regulating breastfeeding and infant nutrition is reviewed. WHO has always fostered infant nutrition, but took up the subject of breastfeeding in 1974 at its 27th World Health Assembly with an expression of concern for decline of the practice. Breastfeeding is a learned behavior in humans that must be supported and reinforced: secular factors are converging to decrease breastfeeding in most of the world. The 1974 assembly set up a working group to initiate research, to collect data on infant nutrition and breastfeeding practices, composition of breast milk in different socioeconomic milieu, methods of conducting controlled studies on mortality in relation to feeding, and effects of hormonal contraceptives on lactation. 3 distinct patterns of feeding were found, among the urban poor, economically advantaged, and rural mothers. A 1979 meeting concluded that monitoring of feeding practices is necessary to set up national programs Training workshops were held and instructive materials were developed. Papers presented at the meeting were published. WHO with UNICEF are promoting the health and social status of mothers, such as nutrition, maternity protection, and support of women's organizations. WHO is collaborating with the International Labor Office (ILO) to survey maternity protection in 129 countries. A final issue being addressed is the infant food industry. In 1985, the World Health Assembly reported that the International Code of Marketing, involving labeling, marketing and regulation of infant foods, has been adopted wholly or in part by 141 countries.
Lancet. 1988 Jun 18; 1(8599):1394-5.At this year's World Health Assembly in Geneva, the UK delegate cited a Department of Health and Social Security circular on breastfeeding and AIDS as a model for member countries. Having now secured the circular, we are shocked to find that the policy deprives babies of the advantages of breastfeeding without anti-HIV testing of the mother. Although the document is said to be applicable to the UK only, such policies if pursued in the majority of WHO member countries will almost certainly lead to greatly increased infant mortality. The ethics of arbitrarily depriving babies of breastmilk without the most careful consideration and testing must be questioned. The International Baby Food Action Network (IBFAN) has issued a statement, entitled Breast Feeding Endorsed: IBFAN Africa Statement on AIDS, which contains the following paragraph. "It is unprofessional to base any recommendations for artificial feeding on guesswork as to a mother's probable HIV status. Possible but unverified risk of HIV infection of either mother or child is not an adequate criterion for any recommendation of artificial feeding. No entire groups of mothers categorized by age, parity, race, national origin, sexual history, place of residence, or economic level, should be advised against breastfeeding." (full text)
POSTGRADUATE MEDICAL JOURNAL. 1986; 62(724):93-6.Breastfeeding has been on the decline in the 3rd world for the past 20 years or so. Modernization has been blamed, yet in the industrialized nations of Sweden, Britain, and the US, women play significant roles in the labor force, are active in professional and public life, and in most Western nations the educated women and those from the professional and upper classes are most likely to breastfeed their babies. Regarding milk substitutes, many products unacceptable in the Western market are on sale in developing nations. In the absence of strong governmental controls, consumer pressure, and professional vigilance, bottle feeding is taken lightly with disasterous consequences. 3 main dangers have been identified: those arising from the nonavailability of protective substances of breast milk to the infant; those arising from the contamination of the feed in a highly polluted environment of poverty and ignorance of simple principles of hygiene; and those arising from overdilution of feeds on the account of the costs of the baby foods. Market forces and competition led the manufacturers of baby foods to stake their claims to the markets of the 3rd world, and almost all of them adopted undesirable promotional methods. The ensuing uproar led to an International Code of Ethics being adopted at the 33rd world Health Assembly under the auspices of the World Health Organization. Although the matter should have rested there, some manufacturers developed their own codes and have persuaded governments to adopt alternative codes. The present situation with regard to infant feeding in the 33rd world should be considered in the context of the international developments identified and also in light of several social and demographic processes. At the current rates of growth in population up to 80% of humanity will be living in the 3rd world by the end of the 20th century. The 2nd demographic phenomenon of social and political significance is the unprecedented increase in the growth of the urban population with national health and social services failing to respond adequately to the challenge of this growth. In many developing countries national planners and economists are beginning to look upon human milk as an important national resource, and the need for a network of services to ensure the nutrition and health of pregnant and lactating women is obvious and is recognized internationally. With regard to the question of adequacy of breast milk, there are many gaps in knowledge. Each community needs to be studied separately, and those involved in scientific research in 1 environment should resist the temptation of extrapolating the results to communities and societies with a different set of circumstances.
IPPF MEDICAL BULLETIN. 1987 Oct; 21(5):4.In response to concerns that breast milk can transmit human immunodeficiency virus (HIV) infection, the International Planned Parenthood Federation (IPPF) Acquired Immunodeficiency Syndrome (AIDS) Prevention Unit has developed a series of recommendations. A total of 5 infants have reportedly become infected as a result of breastfeeding when their mothers became infected with HIV in the immediate postpartum period. However, there are even more cases in which women in similar circumstances breastfed their infants and HIV infection was not transmitted. The infectivity of breast milk is probably dependent on factors such as the frequency or timing of appearance of HIV in breast milk, the viral titer, the mother's nutritional and immunologic status, maternal exposure to other viruses, parity, and the integrity of mucosal barriers. In addition, there are possible protective effects of breastfeeding, including reduction of the incidence and severity of diarrhea and gastrointestinal infection; reduction of the infection load and possible protection against the progression of HIV-related diseases; and the essential immunologic, nutritional, childspacing, and emotional benefits to the child. For all these reasons, it is recommended that breastfeeding by the biologic mother should be the feeding method of choice regardless of her HIV antibody status. If the mother cannot breastfeed, the use of pooled or alternative sources of human milk should be considered. In addition, further research is required to determine whether antibody in breast milk is protective and the factors that affect secretion of HIV in breast milk.
London, International Planned Parenthood Federation, 1984. 43 p. (IPPF Medical Publications)This booklet, for health care workers in developing countries, reviews the fertility-controlling effects of breastfeeding, its strengths and limitations as an element in family planning, and how to provide modern methods of contraception to lactating women. Breastfeeding currently provides about 30% more protection against pregnancy in developing countries than all of the organized family planning programs. The recent trend toward a falling off in the practice of breastfeeding poses a threat to infant welfare and a danger of increased fertility. Health workers are urged to reach pregnant women in the community with knowledge about the value of breastfeeding versus bottle feeding. Each country must set its own policies concerning contraception for lactating women. It is preferable for lactating women to use nonhormonal methods, but if selected, they should not be used too early. Lowest-dose preparations, especially progestogen-only pills, are preferable. Determination of when to start contraception during lactation should be based on breastfeeding patterns in the community, the age at which supplementary foods are introduced, usual birth spacing intervals, and the mean duration of lactation amenorrhea. If the usual time of resumption of menstruation in a given community is known, a rough guide to the optimal time for starting contraception is returning menstruation minus 2 months.