Lactational amenorrhea plays an important role in child spacing. Recent research has led to a consensus regarding the status of lactational amenorrhea as a method of family planning. This is currently referred to as the lactational amenorrhea method. Research priorities were to field test the lactational amenorrhea method and define the factors that influence lactational amenorrhea and the interface between the lactational amenorrhea method and other family planning methods.
PIP: Breastfeeding as a natural method for child spacing is identified as having 4 areas of research agreement. These ideas contribute to the justification that breastfeeding needs to be protected and promoted as an international health objective. 1) It is formally recognized that breastfeeding is associated with reduced fertility through the duration of amenorrhea, which could be at its longest 2 years. 2) Inhibition of ovulation through gonadotropin suppression is an important factor in lactational amenorrhea. After the return of menses, fertility may only be slightly reduced. 3) Suckling dependency is very important in order to maintain lactational amenorrhea. Although no minimum level of suckling has been defined for universal practice to maintain lactational amenorrhea, it has been found that those mothers who suckle frequently for long periods and breastfeed at night have a longer lactational amenorrhea. 4) Lactational amenorrhea is a significant contributor to reduced fertility in terms of completed family size and birth spacing. This is important in countries where artificial contraception is low. Future research is discussed in terms of the progress made in the Bellagio Concensus statement. This statement affirms that if in the 1st 6 months mother maintain full breastfeeding and amenorrhea, the pregnancy rate is 2%. Guidelines have been developed for the lactational amenorrhea method (LAM). Research needs are to test these guidelines in field studies in different cultural settings, in order to provide a stronger base upon which to advise postpartum mothers. Another priority is to define more completely the factors affecting the duration of lactational amenorrhea; i.e., maternal nutrition, racial differences, individual biologic variation, and maternal illness. At present there is a multicenter study conducting such exploration among 500 women/center. Funding and support are from the WHO and the Institute for International Studies in Natural Family Planning. Future studies need to address the interface between LAM and other family planning methods in order to determine when to optimally introduce artificial contraception. Using LAM contributes to cost savings. The last research priority is to disseminate accurate and effective information on LAM to health workers and breastfeeding mothers. Operations research is necessary to determine the best ways to use LAM in developed and developing countries.