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a) The duration of LAM protection may be extended for a few months in amenorrheic women, in certain country situations, through support for optimal breastfeeding practices.
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a) Prenatal breastfeeding education and information on LAM can increase the duration of breastfeeding, lactational amenorrhea, and LAM protection.
- Pugin E, Valdez V, Labbok M, Perez A, Aravena R. Does prenatal education contribute to the duration of full breastfeeding in a comprehensive breastfeeding promotion program? Journal of Human Lactation 1996;12:15-20.
- Cooney KA, Nyirabukeye T, Labbok M, Hoser P, Ballard E. Assessment of the nine-month Lactational Amenorrhea Method (MAMA-9) in Rwanda. Studies in Family Planning 1996;24:162-71.
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b) The extended versions of LAM (e.g., LAM-9, MAMA-9, LAM-12) are based on amenorrhea and maintenance of a high frequency pattern of breastfeeding, with fully or nearly fully breastfeeding, and with breastfeeding before each supplemental feed.
Lactational amenorrhea beyond six months postpartum conveys a good deal of protection from pregnancy, although it provides less protection than in the first six months.
As with standard LAM, use of another method should be encouraged when menses return. If she is amenorrheic, before the woman ceases to fully or nearly fully breastfeed, she should return for counseling (either to continue relying on extended LAM, or for another contraceptive method if she wishes) (See Question 1).
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b) The probability of becoming pregnant during lactational amenorrhea is low during the first six months postpartum. While the risk of pregnancy during lactational amenorrhea is higher after six months postpartum, among women with intensive breastfeeding practices the failure rate for lactational amenorrhea up to one year postpartum is comparable to the perfect use failure rates for other reversible methods. However, more research is needed on the efficacy of the extended Lactational Amenorrhea Method.
- Kennedy KI, Visness C. Contraceptive efficacy of lactational amenorrhoea. Lancet 1992;339:227-30.
- Kazi A, Kennedy KI, Visness C, Khan T. Effectiveness of the lactational amenorrhea method in Pakistan. Fertility and Sterility 1995;64:717-23.
- Ramos R, Kennedy KI, Visness C. Effectiveness of the Lactational Amenorrhea Method in preventing pregnancy in Manila, the Philippines. British Medical Journal 1996;313:909-12.
- Cooney KA, Nyirabukeye T, Labbok M, Hoser P, Ballard E. Assessment of the nine-month Lactational Amenorrhea Method (MAMA-9) in Rwanda. Studies in Family Planning 1996;24:162-71.
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