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a) Backup methods are not necessary while the LAM criteria are met. However, another method can be used during the period of LAM protection if the woman so wishes. Backup methods should be limited to methods that are appropriate for breastfeeding women.
According to the World Health Organization (WHO), progestin-only methods (e.g., Progestin-only pills, Depo Provera® NORPLANT®) should not be initiated before six weeks postpartum, and estrogen-containing methods (e.g. COCs, CICs) should not be started by breastfeeding women before six months postpartum.
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a) While the LAM criteria are met, LAM is a very effective contraceptive method.
- Perez A, Labbok M, Queenan J. Clinical study of the Lactational Amenorrhoea Method for family planning. Lancet 1992;339:968-70.
Non-hormonal methods have no effect on lactation or the infant. Progestin-only methods have no known effect but are WHO Category 3 for theoretical concerns. Estrogenic methods should generally not be used by breastfeeding women prior to six months postpartum due to their effects on lactation (WHO Category 3/4).
- World Health Organization. Improving access to quality care in family planning: medical eligibility criteria for contraceptive use. Geneva: WHO, 1996.
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b) It is appropriate for a LAM user to have a contraceptive method on hand that she can initiate herself. A woman should have the opportunity to make an informed choice to begin any other method which is appropriate for her while she is still protected by LAM. She can then initiate that method when the LAM criteria no longer hold or she chooses to end reliance on LAM.
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b) The method a LAM user has on hand (for use after she is no longer relying on LAM) may be a woman's chosen follow-up method, or it may be for use as a temporary complementary method until she has a chance to visit her family planning provider to procure the method she desires. A service provider can be reasonably sure that a LAM user is not pregnant provided that the LAM criteria are met. The provider can then provide the chosen method (as per the protocol for that method) before the end of LAM.
- Perez A, Labbok M, Queenan J. Clinical study of the Lactational Amenorrhoea Method for family planning. Lancet 1992;339:968-70.
Having a contraceptive method on hand that the user can initiate herself when LAM expires (or when the woman no longer wishes to rely on LAM) is thought to have the potential of reducing the chance of a gap in protection.
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c) If a woman using LAM becomes at risk for sexually transmitted diseases (STDs), including HIV/AIDS, she may need to initiate use of condoms or other barrier methods for STD protection, in addition to LAM.
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c) LAM does not offer protection from STDs or HIV. Clients at risk for these diseases should be encouraged to use barrier methods and counseled about behaviors that can decrease risk. |
