Recommendations for Contraceptive Use
		Progestin-Only Pills During Breastfeeding

Recommendations	Rationale
a) Women can rely on POPs after the first six weeks postpartum, and safely use them during the entire duration of breastfeeding.	a) In general, POPs are highly effective, and safe, during breastfeeding. McCann MF, Potter LS. Progestin-only oral contraception: a comprehensive review. Contraception 1994;50(6). Dunson TR, McLaurin VL, Grubb G, Rosman A. A multicenter clinical trial of a progestin-only oral contraceptive in lactating women. Contraception 1993;47:23-35.
b) Women can continue using POPs after they stop breastfeeding, provided that they have been informed of the advantages and disadvantages of the method and are willing to use the POPs correctly and consistently. It is not mandatory for a woman to switch from POPs to another family planning (FP) method after she stops breastfeeding or at six months postpartum.	b) POPs are an effective contraceptive method, even when not breastfeeding, if used correctly and consistently. However, all women should be informed of the advantages and disadvantages of POPs in the absence of breastfeeding, especially that POPs need to be used consistently and correctly to provide effective pregnancy protection (e.g., the pill should be taken at the same time each day), and that they often cause irregular menstrual bleeding. Visness C, Rivera R. Progestin-only pill use and pill switching during breastfeeding. Contraception 1995;51:279-81. McCann MF, Potter LS. Progestin-only oral contraception: a comprehensive review. Contraception 1994;50(6). World Health Organization. Improving access to quality care in family planning: medical eligibility criteria for contraceptive use. Geneva: WHO, 1996.
c) Breastfeeding women using POPs should be advised not to switch to combined oral contraceptives (COCs), or other methods containing estrogen, until at least six months postpartum.	c) Even low-dose (30 mcg) COCs decrease breastmilk production and alter its composition. WHO Task Force on Oral Contraceptives. Effects of hormonal contraceptives on milk volume and infant growth. Contraception 1984;30:505-21. McCann MF, Potter LS. Progestin-only oral contraception: a comprehensive review. Contraception 1994;50(6).
d) Breastfeeding women can switch to non-hormonal methods at any time, as appropriate.	d) If not inserted with 48 hours of delivery, postpartum IUDs are usually not inserted until uterine involution is complete. Progestin-releasing IUDs are not inserted until six weeks postpartum, even if involution is complete before six weeks, to avoid the theoretical risks of infant steroid exposure. Diaphragms are not fitted until involution is complete. O'Hanley K, Huber D. Postpartum IUDs: keys for success. Contraception 1992;45:351-61. Wiley A. The Diaphragm. In: Corson S, Derman R, Tyrer L, editors. Fertility Control. Boston: Little, Brown & Company, 1985:223-32. World Health Organization. Improving access to quality care in family planning: medical eligibility criteria for contraceptive use. Geneva: WHO, 1996.

Any part of Recommendations for Updating Selected Practices in Contraceptive Use may be reproduced or adapted to meet local needs without prior permission from the TG/CWG Secretariat, provided the TG/CWG is acknowledged and the material is made available free of charge or at cost.