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Medical Eligibility Criteria for Contraceptive Use: A WHO Family Planning Cornerstone. 4th edition. Geneva: World Health Organization; 2010.

Cover of Medical Eligibility Criteria for Contraceptive Use

Medical Eligibility Criteria for Contraceptive Use: A WHO Family Planning Cornerstone. 4th edition.

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LACTATIONAL AMENORRHOEA METHOD (LAM)

The lactational amenorrhoea method does not protect against STI/HIV. If there is a risk of STI/HIV (including during pregnancy or postpartum), the correct and consistent use of condoms should be recommended, either alone or with another contraceptive method. Male latex condoms are proven to protect against STI/HIV.

Women with conditions that make pregnancy an unacceptable risk should be advised that the lactational amenorrhoea method may not be appropriate for them because of its relatively higher typical-use failure rates.

The Bellagio Consensus provided the scientific basis for defining the conditions under which breastfeeding can be used safely and effectively for birth-spacing purposes, and programmatic guidelines were developed for the use of lactational amenorrhoea in family planning. These guidelines include the following three criteria, all of which must be met to ensure adequate protection from an unplanned pregnancy: (1) amenorrhoea; (2) fully or nearly fully breastfeeding; and (3) less than six months postpartum.

The main indications for breastfeeding remain the need to provide an ideal food for the infant and to protect it against disease. There are no medical conditions in which the use of lactational amenorrhoea is restricted and there is no documented evidence of its negative impact on maternal health. However, certain conditions or obstacles which affect breastfeeding may also affect the duration of amenorrhoea, making this a less useful choice for family planning purposes. These include:

HIV INFECTION

Breastfeeding should be promoted, protected, and supported in all populations, for all women who are HIV-negative or of unknown HIV status. A woman infected with HIV, however, can transmit the virus to her child through breastfeeding. Yet breastfeeding, and especially early and exclusive breastfeeding, is one of the most critical factors for improving child survival. Breastfeeding also confers many other benefits in addition to reducing the risk of death.

There is now strong evidence that giving antiretroviral drugs (ARVs) to either the HIV-infected mother or HIV-exposed infant or both can significantly reduce the risk of transmitting HIV through breastfeeding (http://www.who.int/hiv/topics/mtct). This transforms the landscape in which decision should be made by national health authorities and individual mothers. In the presence of ARVs, either lifelong antiretroviral therapy to the mother or other ARV interventions to the mother or infant, the infant can receive all the benefits of breastfeeding with little risk of becoming HIV infected. In some well-resourced countries with low infant and child mortality rates, avoidance of all breastfeeding will still be appropriate.

HIV-infected mothers should receive the appropriate ARV interventions and should exclusively breastfeed their infants for the first 6 months of life, introducing appropriate complementary foods thereafter, and continue breastfeeding for the first 12 months of life. Breastfeeding should then only stop once a nutritionally adequate and safe diet without breast milk can be provided. When mothers decide to stop breastfeeding, they should stop gradually within one month and infants should be provided with safe and adequate replacement feeds to enable normal growth and development.

Mothers known to be HIV infected should only give commercial infant formula milk as a replacement feed to their HIV-uninfected infants or infants who are of unknown HIV status, when specific conditions are met:

  1. safe water and sanitation are assured at the household level and in the community, and,
  2. the mother, or other caregiver can reliably provide sufficient infant formula milk to support normal growth and development of the infant, and,
  3. the mother or caregiver can prepare it cleanly and frequently enough so that it is safe and carries a low risk of diarrhoea and malnutrition, and,
  4. the mother or caregiver can, in the first six months, exclusively give infant formula milk, and,
  5. the family is supportive of this practice, and,
  6. the mother or caregiver can access health care that offers comprehensive child health services.

If infants and young children are known to be HIV infected, mothers are strongly encouraged to exclusively breastfeed for the first 6 months of life and continue breastfeeding as per the recommendations for the general population, that is up to two years or beyond.

Women who are HIV infected should receive skilled counselling to help them. They should also have access to follow-up care and support, including family planning and nutritional support.

MEDICATION USED DURING BREASTFEEDING

In order to protect infant health, breastfeeding is not recommended for women using such drugs as: anti-metabolites, bromocriptine, certain anticoagulants, corticosteroids (high doses), ciclosporin, ergotamine, lithium, mood-altering drugs, radioactive drugs and reserpine.

CONDITIONS AFFECTING THE NEWBORN

Congenital deformities of the mouth, jaw or palate; newborns who are small-for-date or premature and needing intensive neonatal care; and certain metabolic disorders of the infant can all make breastfeeding difficult.

Copyright © 2010, World Health Organization.

All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw@sredrokoob). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: tni.ohw@snoissimrep).

Bookshelf ID: NBK138631
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