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Stud Fam Plann. 1981 Apr;12(4):125-33.

The contraceptive effect of breastfeeding.



The fertility-reducing impact of breastfeeding, the hormonal mechanism of lactational amenorrhea, the cultural and individual behavioral variables that influence the hormonal mechanism and the duration of amenorrhea, and the policy implications of extending postpartum protection by using lactational amenorrhea as a complementary contraceptive are discussed. Recent studies indicate that the contraceptive effect of lactational amenorrhea is considerable, with use-effectiveness rates comparable to those of oral contraceptives, the condom, or the diaphragm; according to 1 estimate, breastfeeding provides 35 million couple-years of protection annually in developing countries, compared with 27 million provided by family planning programs. The contraceptive effect of breastfeeding is largely lost after the return of menstruation. The physiological processes by which lactation inhibits the ovulatory cycle in humans are poorly understood, although a close association is known to exist between frequent sucking, high prolactin levels, altered LH secretion, and amenorrhea. The length of the breastfeeding period and the timing of the addition of supplementary foods influence both the duration of amenorrhea and the frequency and intensity of nursing. Maternal age and demand vs. scheduled feeding may be secondary factors affecting the duration of amenorrhea. Cultural beliefs and norms regarding breastfeeding practices are of extreme significance in determining the duration of lactational amenorrhea. Flexible family planning programs which encourage the continuation of breastfeeding while promoting the use of appropriate contraceptive methods initiated when they will affect fertility are needed in developing countries.

[Indexed for MEDLINE]

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