Birth Control by Breastfeeding

(The Lactational Amenorrhea Method)

The LAM user should be counseled to use another contraceptive method for continued protection when: 

1. Her menstrual periods return.  
Menstrual bleeding is the most important indicator of fertility.  After the initial 56 days postpartum, two consecutive days of bleeding/spotting or the woman's perception that her period has returned, whichever of the two comes first, should be considered an indication that fertility is returning.  A woman can ovulate before her period returns, however, studies indicate this rarely occurs when the woman is breastfeeding intensively and less than six months postpartum.   OR 

2. She begins feeding her baby other liquids or foods regularly, or her baby sleeps through the night.  
Ovulation is suppressed in the breastfeeding woman as the baby suckles at the breast. When the baby begins taking other foods or liquids she/he generally suckles at the breast less, thus reducing the fertility-suppressing effect of breastfeeding.  This is also true when the baby begins sleeping through the night -- long intervals between breastfeeds (more than four hours during the day and six hours at night) should be avoided.   OR 

3. Her baby is older than six months. 
At about six months the baby should begin eating other foods as their nutritional needs change at this time.  Usually the baby will breastfeed less when this happens, thus, LAM becomes less effective. 

Any one of these changes will reduce LAM's high efficacy. At this time, the LAM user should be counseled about complementary family planning methods that do not interfere with breastfeeding. 

Medical conditions when LAM would not be advisable 
Medical conditions that affect the use of LAM are few. Generally, the conditions listed below make breastfeeding inadvisable, which in turn makes LAM use impossible. 

LAM should not be used under the following conditions:  

• Specific infant metabolic disorders. 
• Maternal use of mood-altering drugs. 
• Maternal use of reserpine, ergotamine, antimetabolites, cyclosporine, bromocriptine, radioactive drugs, lithium, or anticoagulants. 

LAM usually is not recommended under the following conditions, except on the basis of careful clinical judgement, taking into account the severity of the condition and the availability and acceptability of other methods: 

AIDS or confirmed HIV+. The HIV virus can be passed through breastmilk.  According to the World Health Organization, if a safe alternative to breastfeeding is available and affordable, a woman who is HIV+ or has AIDS should be informed of the risks of breast and bottle feeding. 

Active tuberculosis. Tuberculosis does not spread through breastmilk but through direct contact with the mother.  If the mother has an active case of tuberculosis, breastfeeding increases the risk of infection due to the frequent and intimate contact with the infant.  

This page was adapted from the original web site of the Institute for Reproductive Health, a project funded by the United States Agency for International Development (USAID) under the terms of Cooperative Agreement DPE-3061-A-00-1029-00.  Information (photos excluded) and publications may be reproduced, adapted, and disseminated without permission, provided the Institute for Reproductive Health is acknowledged and the material is distributed free of charge, or not for profit. 

The LAM section was originally developed by Shirley Coly