Breastfeeding can play a major role in fertility regulation in developing countries. The effect of breastfeeding is enhanced when the incidence of breastfeeding is high and the duration extended. These factors are more likely to occur when suckling at the breast is frequent. Sociological and behavioral factors can also influence a woman's decision to initiate and terminate breastfeeding. The effects of urbanization, maternal education, and socioeconomic status act through the intervening variables of sociocultural factors, health services, employment status of women, and availability of breastmilk substitutes. Strategies to alter these intervening variables include educational campaigns and support groups for lactating women, changes in health services, availability of child care facilities near employment centers, and enforcement of the international code of marketing of breastmilk substitutes.
PIP: Breastfeeding can play a major role in fertility regulation in developing countries. This paper examines those influences that have been attempted, or those that have a realistic potential, to determine the effect of breastfeeding on fertility. Factors that enhance the incidence and duration of breastfeeding are likely to result in improvements in child health as well as fertility. A major factor affecting natural fertility is postpartum infecundity. In most countries, the incidence of initiation and the duration of breastfeeding are highly correlated. The effect of breastfeeding is enhanced when the incidence is high and the duration extended. These factors are more likely to occur when suckling is frequent. Populations exhibiting early supplementation with substantial contributions in terms of nutrients have shorter durations of amenorrhea. Maternal activity patterns affect suckling. Suckling patterns can affect the initiation and duration of breastfeeding through physiologic mechanisms. Changes in breastfeeding behavior are caused by social, cultural, and economic influences on parental attitudes and behavior in relation to self-images. Health care services in most developing countries have been associated with lower rates of initiation of breastfeeding and shorter durations. The effect of the employment status of women on breastfeeding is discussed. There is an association between marketing of breastmilk substitutes and influences on decreasing breastfeeding. Policies to promote breastfeeding include educational campaigns and support groups for lactating women, changes in health services, availability of child care facilities near employment centers, and enforcement of the international code of marketing of breastmilk substitutes.