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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.
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, 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.
In: Jelliffe DB, Jelliffe EF, Sai FT, Senanayake P, eds. Lactation, fertility and the working woman. London, International Planned Parenthood Federation, 1979. 7-9.The principal objective of the International Planned Parenthood Federation (IPPF) -- an international federation of 95 voluntary national family planning associations with operations in 110 countries -- is to enable people to practice responsible parenthood as a matter of human right, family welfare, and the well-being of the community. A second IPPF objective is to increase understanding on the part of people and governments of the demographic problems existing in their communities and the world. In the area of lactation the IPPF has had several activities in the past few years. 1 activity was a Biological Sciences Workshop on Lactation and Contraception in November 1976. A 2nd activity is a study on breastfeeding being conducted in collaboration with the World Health Organization (WHO). The Central Medical Committee of the IPPF passed a resolution early in 1976 which states that lactation is a good thing in itself, that breastfeeding is the best way of feeding an infant in the early months, if not the early years of its life, and that breastfeeding is a good contraceptive in its own right. A definite advantage of breastfeeding is that there is more avoidance of pregnancy and more protection of women from unwanted pregnancy by breastfeeding than by all combined scientific technology in family planning based programs. Some of the problems of breastfeeding and outside work relate to sheer expense, both in a positive and negative sense. There is also the question of inconvenience of breastfeeding. 1 approach to the disadvantages has been prolonged maternity leave with pay. Another approach is causing the child to invert its feeding rhythm.