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BULLETIN OF THE WORLD HEALTH ORGANIZATION. 1990; 68(5):625-31.Lactational amenorrhea in many developing countries is still the most successful form of contraception, especially when modern forms of contraception are not available. In cultures where frequent or prolonged breast feeding is common, postpartum amenorrhea and suppressed ovulation are frequent and serve to space births. It is this spacing of births that leads to decreased infant and maternal morbidity and mortality. It must be remembered that lactational amenorrhea is not a completely reliable form of contraception. In fact the figures indicate that in cultures were family planning use is low, birth intervals are largely determined by the duration and intensity of breastfeeding. Studies indicate that an increase of 15% 32% in birth intervals can result from prolonged lactation. It would be to the advantage of health care planners and providers to examined more closely the causes and properties of lactational amenorrhea. Field directed education can provide women with the information necessary to help them control their child spacing. The WHO Breast-feeding Data Bank collects and analyzes information on breast-feeding and its effects on fertility regulation. Methods used to assess lactational infertility and how the information is used by the data bank are described in this article. There is a summary of relevant information gathered from published sources and post 1983 studies of the WHO. The practical implications to health policy that are associated with lactation-associated infertility are also mentioned.
WORLD HEALTH. 1987 Nov; 10-2.Breastfeeding is at times referred to as "nature's contraceptive." Intensive breastfeeding naturally stops the discharge of eggs from the ovaries, which commonly is experienced as a delay in the return of menses after the birth of a baby. An obvious limitation is that for breastfeeding to produce a contraceptive effect, a successful pregnancy and suckling are essential, and it is not possible to predict when the contraceptive protection might cease. Consequently, in terms of fertility regulation, breastfeeding is regarded as a birth spacing rather than as a contraceptive method per se. The sooner a woman starts to menstruate after a birth, the shorter the birth interval is likely to be, assuming the woman is sexually active, there are no miscarriages, and no contraceptives are used. In women who do not breastfeed, the menses usually returns within 2-3 months after delivery. For those who breastfeed intensively for 1 or 2 years, the menses generally return within 6-10 months or 15-18 months, respectively. The ideal way of prolonging the birth interval seems to be by combining prolonged breastfeeding with the commencement of contraceptive use at the appropriate time, provided this time were known. Without breastfeeding and contraceptive use, the birth interval averages 16 months, but with prolonged and intensive breastfeeding it potentially could be extended by another 18 months, giving an average interval of 34 months. This suggests that the fertility of women who do not breastfeed could be halved by breastfeeding alone. The tendency for fertility to increase during the early stages of modernization is observed in countries where the trend away from a traditional of prolonged breastfeeding is not accompanied by increased use of modern contraceptive methods. It is known widely that breastfeeding helps to postpone the next pregnancy, practices and beliefs vary by region and ethnic group. For a long time, the World Health Organization Special Program of Research, Development and Research Training in Human Reproduction has been involved in the study of natural methods of fertility regulation, and it is important that WHO continues to study breastfeeding in different ethnic and social group if it intends to give sound advice on this issue to family planning programs.
Studies in Family Planning. 1986 May-Jun; 17(3):153-60.Data from a prospective child health study conducted in Gaza by the WHO was used to examine the relationship between infant feeding and subsequent fertility. The study group consisted of 769 women living in 2 refugee camps in Gaza who gave birth in a 2-month period in 1978, and their index children, followed up for 23 months with monthly visits. Women who became pregnant within the 23 months were followed up until the end of their pregnancy. Women who practiced contraception after the birth of the index child were excluded. Life table analyses demonstrate a strong relationship between breastfeeding and 2 components of birth intervals, the postpartum anovulatory period and the waiting time from the end of the anovulatory period to conception. Duration of breastfeeding in this population averaged 12 months. Once menses have resumed, main factors related to waiting time to conception are age, husbands education, and measures of breastfeeding intensity and duration. Women who are breastfeeding when menstruation resumes and continue to do so are less likely to conceive than other women.