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Am J Clin Nutr. 1982 Jan;35(1):162-71.

Breast-feeding and family planning: a review of the relationships between breast-feeding and family planning.


A number of interrelated factors must be considered when breast-feeding is introduced as a concern for family planning programs: the number of pregnancies and births experienced, age at each pregnancy and birth, duration of the intervals between conceptions, lactation including duration and type, health and nutritional services available to meet the demands of pregnancy, delivery, and postpartum care. The dietary intake of the mother and her health and disease status have an effect on the duration of breast-feeding, and lactation has an effect on her ovulation and birth spacing. Those at particularly high risk include adolescent girls, older grand-multipara women, and families living in poverty. An historical relationship between the reduction in infant and childhood mortality and the falling off of births can be documented. The straightforward benefits on nutritional status of breast-fed infants, the conjunction with the antibody protection afforded by breast milk, served to reduce infant mortality and indirectly served to reduce birth rates. In addition, the prolongation of postpartum anovulatory cycles in breast-feeding women, coupled with sexual mores that postpone sexual relations while a women is breast-feeding in certain groups, will serve to prolong the interbirth intervals. Populations where breast-feeding is customary have been shown to have fewer births than populations where the women do not breast-fed and where infants are artificially fed.


Public health workers and social scientists favor breastfeeding because of the relationship between breastfeeding, infant survival, and family planning. Family planning in developing countries is a major concern among health professionals particularly because of the annual population growth rate of nearly 3% in these countries. Breastfeeding studies in West African villages, rural Philippines, Europe, India, and Taiwan show that breastfeeding prolongs interbirth intervals up to 35 months. It is calculated that breastfeeding in urban areas of developing countries would annually provide 3.4 million couple-years of protection against fertility, while for rural areas, the estimate is 34.7 million couple-years. Authors generally agree that lactation is usually associated with prolongation of postpartum amenorrhea. Because a lengthy period of lactation delays ovulation, this period of ovarian inactivity has been described as physiological castration. Postpartum amenorrhea may be influenced by seasonal patterns, as well as malnutrition of the mother. Other lactation factors which affect amenorrhea and prolongation of interbirth intervals are: 1) undernutrition of the breastfeeding woman, 2) taking of birth control pills, 3) cultural factors that include abstinence from sexual intercourse until weaning, 4) maternal age, and 5) education. Birth intervals are also affected by infant survival. The death of a child shortens the birth interval partly because of the absence of postpartum amenorrhea with lactation. In addition, parents tend to replace children who have died. This information could provide the basis for program development which would enhance the conscious awareness of better child survival through the combination of child care and family planning. The woman's age and temporary separations between spouses also affect pregnancy interval, as do the mother's health and nutritional status. Adolescents and older women are at high risk for problems during both pregnancy and lactation. Family planning programs should aim at improving adolescent nutrition, delaying 1st pregnancy, widening birth intervals, lowering parity, and encouraging both lactation and family planning.

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