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Sci Am. 1984 Apr;250(4):35-41.

Breast feeding.



At this time the fact that breastfeeding can play an important contraceptive role has become little more than a myth in the minds of many people. The change has had serious consequences for rates of population increase and for infant health, particularly in many developing nations. In developed countries breastfeeding is generally regarded as an aftermath of human reproduction. The medical profession has largely ignored the subject. The failure of physicians, scientists, theologicans, administrators, and politicians in developed countries to appreciate the full significance of breastfeeding for the spacing of births and the health of infants has had serious consequence for developing countries. The recent World Fertility Survey showed that in many developing countries young women who are educated, urban, and affluent are abandoning breastfeeding in favor of bottle feeding. The exact mechanism by which suckling inhibits fertility is not totally understood. It clearly is the suckling stimulus itself, rather than the production of milk, that is crucial. In women the sensitivity of the nipple increases markedly at the time the baby is born. The phenomenon may be important for enhancing inhibitory inputs to the brain. A reasonable hypothesis to explain the contraceptive effect of breastfeeding is that neural inputs from the nipple reach the hypothalamus. There they have the effect of stimulating the release of beta endorphin, which is thought to suppress the discharge of hypothalamic gonadotrophin releasing hormone. The result is decreased secretion of luteinizing hormone and therefore a failure of ovulation. In many countries, both developing and developed, it is common for the mother to start feeding the baby supplements early, sometimes from the day of birth. This practice diminishes the supply of breast milk, exposing the baby to an unnecessary risk of infection and undermining the contraceptive effect of breastfeeding. Another current controversy is the type of contraceptive a lactating mother should use and the time for her to start using it. In developed countries, where women usually breastfeed for a relatively short period of time and where they take for granted the availability of an almost foolproof method of contraception, the practice has been to advocate barrier methods. In developing countries the situation is totally different. The contraceptive protection afforded by lactational amenorrhea is at least as good as that of any modern contraceptive. A most effective and safe contraceptive for lactating women in developing countries and the simplest to administer is Depo-Provera. The controversy regarding the use and risks of Depo Provera are reviewed.

[PubMed - indexed for MEDLINE]
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