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Recommendations for Contraceptive Use |
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Lactational Amenorrhea Method |
Classification of Selected
Procedures for the Lactational Amenorrhea Method (LAM)
| Procedure |
Class |
Rationale |
| Pelvic examination (speculum and
bimanual) |
C |
- A pelvic exam is not necessary to ensure safe use of LAM as
a contraceptive method.
- A pelvic exam may help evaluate the question of pregnancy.
In this case, it is Class A.
|
| Blood pressure |
C |
LAM does not affect blood
pressure. |
| Breast examination |
C |
- In certain cases, examination of the breasts and
appropriate counseling and/or treatment may assist women to successfully breastfeed. In
this case, it is Class B.
- LAM does not cause breast cancer. In fact, breastfeeding
may reduce the risk of breast cancer1,2.
|
| Sexually transmitted disease
(STD) screening by lab tests (for asymptomatic persons) |
C |
Clients at risk for STDs (by
personal history or socio-demographic risk factors) should be offered STD screening, where
possible. However, the presence of an STD, other than human immunodeficiency (HIV), will
not affect the safe use of LAM. |
| HIV screening |
B |
- Breastfeeding women at risk for STDs, including HIV, should
be advised that if they are HIV-positive or should acquire HIV during the course of
lactation, there is a risk of transmitting the virus to their infants through their
breastmilk3.
- Where safe alternatives to breastmilk are not readily
available, HIV-positive women should still be advised to breastfeed; those women who are
HIV-positive and who can safely bottlefeed should be advised to do so4,5.
|
| Cervical cancer screening |
C |
Cervical cancer screening is not
needed for the safe use of LAM6. |
| Proper infection prevention
procedures |
C |
Infection prevention procedures
are not applicable to LAM use. |
Specific counseling points for
LAM:
- LAM criteria
- efficacy
- optimal breastfeeding behaviors
- when and where to obtain follow-up method
- signs and symptoms for which to see a health provider
- STD protection (when/as appropriate)
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A |
- LAM is an educational method, so appropriate client
counseling and education is of the utmost importance. LAM users must learn the three LAM
criteria, the importance of using another method before the criteria no longer apply, and
where they can receive the method of their choice. Counseling regarding the breastfeeding
behaviors which are optimal for maintaining lactational infertility is also important7.
- Accurate client education is essential for maximum quality
of family planning services.
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KEY:
Class A = essential and mandatory or otherwise
important in all circumstances, for safe and effective use of the contraceptive method
Class B = medically/epidemiologically rational in
some circumstances to optimize the safe and effective use of the contraceptive method, but
may not be appropriate for all clients in all settings
Class C = may be appropriate for good preventive
health care, but not materially related to safe and effective use of the contraceptive
method
Class D = not materially related to either good
preventive health care or safe and effective use of the contraceptive method
Citations for Procedures Table:
- United Kingdom National Case-Control
Study Group. Breast feeding and risk of breast cancer in young women. British Medical
Journal 1993;307:17-20.
- Thomas DB, Noonan EA and the WHO
Collaborative Study of Neoplasia and Steroid Contraceptives. Breast cancer and prolonged
lactation. International Journal of Epidemiology 1993;22:619-26.
- Van de Perre P, Simonon A, Msellati P,
Hitimana D, Vaira D, Bazubagira A, et al. Postnatal transmission of human immunodeficiency
virus type 1 from mother to infant. New England Journal of Medicine 1991;325:593-8.
- Nicoll A, Newell M-L, Van Praag E, Van
de Perre P, Peckham C. Infant feeding policy and practice in the presence of HIV-1
infection. AIDS 1995;9:107-19.
- Van de Perre P. Postnatal transmission
of human immunodeficiency virus type 1: the breast-feeding dilemma. American Journal of
Obstetrics and Gynecology 1995;173:483-7.
- World Health Organization. Improving
access to quality care in family planning: medical eligibility criteria for contraceptive
use. Geneva: WHO, 1996.
- Labbok M, Cooney K, Coly S.
Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea Method-LAM.
Washington, DC: Institute for Reproductive Health, 1994.
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