Effectiveness depends on the user: Risk of pregnancy is greatest when a woman cannot fully or nearly fully breastfeed her infant.

• As commonly used, about 2 pregnancies per 100 women using LAM in the first 6 months after childbirth. This means that 98 of every 100 women relying on LAM will not become pregnant.
• When used correctly, less than 1 pregnancy per 100 women using LAM in the first 6 months after childbirth.

Return of fertility after LAM is stopped: Depends on how much the woman continues to breastfeed

Protection against sexually transmitted infections: None

Side Effects

None. Any problems are the same as for other breastfeeding women

Known Health Benefits

Helps protect against:

• Risks of pregnancy

Encourages:

• The best breastfeeding patterns, with health benefits for both mother and baby

Known Health Risks

• None

The lactational amenorrhea method:

• Is highly effective when a woman meets all 3 LAM criteria.
• Is just as effective among fat or thin women.
• Can be used by women with normal nutrition. No special foods are required.
• Can be used for a full 6 months without the need for supplementary foods. Mother’s milk alone can fully nourish a baby for the first 6 months of life. In fact, it is the ideal food for this time in a baby’s life.
• Can be used for 6 months without worry that the woman will run out of milk. Milk will continue to be produced through 6 months and longer in response to the baby’s suckling or the mother’s expression of her milk.

All breastfeeding women can safely use LAM, but a woman in the following circumstances may want to consider other contraceptive methods:

• Has HIV infection (see The Lactational Amenorrhea Method for Women With HIV, next page)
• Is using certain medications during breastfeeding (including mood­altering drugs, reserpine, ergotamine, anti-metabolites, cyclosporine, high doses of corticosteroids, bromocriptine, radioactive drugs, lithium, and certain anticoagulants)
• The newborn has a condition that makes it difficult to breastfeed (including being small-for-date or premature and needing intensive neonatal care, unable to digest food normally, or having deformities of the mouth, jaw, or palate)

Problems With Use

• Problems with breastfeeding or LAM affect women’s satisfaction and use of the method. If the client reports any problems, listen to her concerns, give her advice and support, and, if appropriate, treat. Make sure she understands the advice and agrees.
• Offer to help the client choose another method—now, if she wishes, or if problems cannot be overcome.

1. Can LAM be an effective method of family planning?

Yes. LAM is effective if the woman’s monthly bleeding has not returned, she is fully or nearly fully breastfeeding, and her baby is less than 6 months old.

2. When should a mother start giving her baby other foods besides breast milk?

Ideally, when the baby is 6 months old. Along with other foods, breast milk should be a major part of the child’s diet through the child’s second year or longer.

3. Can women use LAM if they work away from home?

Yes. Women who are able to keep their infants with them at work or nearby and are able to breastfeed frequently can rely on LAM as long as they meet all 3 criteria for LAM. Women who are separated from their infants can use LAM if breastfeeds are less than 4 hours apart. Women can also express their breast milk at least every 4 hours, but pregnancy rates may be slightly higher for women who are separated from their infants. The one study that assessed use of LAM among working women estimated a pregnancy rate of 5 per 100 women during the first 6 months after childbirth, compared with about 2 per 100 women as LAM is commonly used.

4. What if a woman learns that she has HIV while she is using LAM? Can she continue breastfeeding and using LAM?

If a woman is newly infected with HIV, the risk of transmission through breastfeeding may be higher than if she was infected earlier, because there is more HIV in her body. The breastfeeding recommendation is the same as for other HIV-infected women, however. HIV-infected mothers and their infants should receive the appropriate ARV therapy, and mothers should exclusively breastfeed their infants for the first 6 months of life, and then introduce appropriate complementary foods and continue breastfeeding for the first 12 months of life. At 6 months—or earlier if her monthly bleeding has returned or she stops exclusive breastfeeding—she should begin to use another contraceptive method in place of LAM and continue to use condoms.